Ch. 1, 7, 8 pt2

How is vocal cord adduction performed?

Place one hand on chair and produce a sustained "ah"-5 times 2. Repeat "ah" with hard glottal attack-5 times

What is Multiple system atrophy?

Sporadic neurological condition characterized by varying combinations of parkinsonism, ataxia, spasticity and autonomic dysfunction.

Describe assessment of Confrontation naming problems?

Standard naming test described in this section on aphasia and client specific procedures the clinician devises (showing objects from the client environment and asking him or her to name them) Will be helpful in assessing these problems

What are the general treatment approaches in acquired language disorders?

Stimulation Facilitation (Cognitive Stimulation and Programmed Stimulation) Behavioral Modification (This one less so with aph., but ok.)

What does a tongue array display?

Strength and symmetry of tongue movement Isometric exercises with visual display targets

Describe strengthening of tongue?

Strengthening the tongue I speech tasks. Bite block goes between the teeth to make the tongue go with out moving the jaw, also good for cp, move the tongue without the jaw.

What is accomplished in the thermal tactile stimulation exercise?

Strokes anterior faucial arches to trigger the swallow. Increase silivia which would then make you swallow

Describe the evidence for movement complexity?

Suggests that progression from simple to more complex behaviors may be less efficient than targeting more complex items early in treatment Consistent with idea behind "challenge-point framework" that learners must be challenged in order for learning to occur.

What causes spasticity/hypertonia?

Supraspinal injury causes an increase in gamma motor neuron discharge and, therefore, Ia afferent activity.

Medical treatment of swallowing disorders

Surgeons are mostly involved in the medical treatment of swallowing disorders as most of the medical procedures are surgical?~~

What are factors affecting errors in AOS?

Syllabicity effects And Complexity at vocal tract gestural level of phonetic encoding predicts probability of errors (e.g., transitions between sounds or syllables)

What are the syllabicity effects?

Syllable frequency Syllable length More syllables = more errors Syllable boundary Clusters within syllables tend to be more difficult than cluster across boundaries (e.g., stake vs. mistake) Word complexity More segments/syllable or syllables/word = more errors

Describe nonsense syllable drills?

facilitate learning of touch cues improve articulatory sequencing develop self-monitoring

-difficulty understanding implied, alternate, or abstract meetings?

failure to grasp the overall meaning of situations or stories, difficulty understanding the central message a conversation, difficulty in describing an underlying theme of a picture or story, problems in appreciating humor, sarcasm, and irony

What is associative visual agnosia?

failure to relate a good percept (you perceived it well) to a representation of the object in memory, recognition problem w/no perceptual deficit; failure to name but can match and copy. Dissociation of recognition from perception tends to be caused by bilateral occipital lesions. (your visual fields cross); They may, for example, know that a fork is something you eat with but may mistake it for a spoon. Patients suffering from associative agnosia are still able to reproduce an image through copying.

What's important about Experienced listeners?

familiar to the speaker versus us who are trained- may not be better.

What causes rigidity?

results when there is an increase in muscle tone that causes resistance to passive movement throughout the whole range of motion.

digastric (anterior belly) function

retracts mandible or pulls hyoid anteriorly

hyoglossus function

retracts the tongue, elevates larynx, lowers the tongue dorsum

What can be done to accomplish this?

rotate head backwards and initiate phonation at high long volumes

lateral cricoarytenoid function

rotates the arytenoid cartilages toward the midline

Describe step2?

same as step 1, except pt's response is delayed simultaneous auditory cue is faded clinician mimes response without sound during pt's response

Describe assessment of Confused language?

if evident initially, maybe assessed with standard interviews and bedside evaluations

Describe feedback timing?

immediate vs. delayed ; Delayed feedback seems to enhance motor skill learning by facilitating internal movement evaluation

What is Rebound?

impaired ability to predict or stop/dampen movement

What does separation of movements do?

large movements broken down into smaller movements and recombined in novel ways leads to new movements Discrete movements emerge when proximal stability develops in all motor systems

How do you sue reflexive phonation?

laughing, coughing, sighing note position that vocalization occurs in note if there is decreased respiratory support, VP incompetence and/or bilateral vocal cord weakness/paralysis

Give an example of a respiratory prosthesis?

lean into a paddle that reduces long volume and keeps pressure up. Other devices that increase respiratory training.

Define Hyporeflexia?

less than the normal amount of reflex. Reflex will be absent or diminished. Can hit the tendon in the

Describe the Global Deterioration Scale?

levels of fucntionign from no cognitive impairment to very sever cognitive decline

What are the characteristics of MTA?

limited spontaneous speech automatic ,involuntary nature of communication sever echolalia severely impaired fluency severely impaired auditory comprehension marked naming difficulty and neologism unimpaired automatic speech severely impaired reading, reading comprehension, and writing.

What are the swallow maneuvars?

supraglottic swallow, super-supraglottic swallow, effortful swallow, mendelsohn maneuver, Neuromuscular Electrical Stimulation

What are the treatments for hypokinetic dyarthria?

surgical, pharmacocoogical and behavioral

What are the treatments of reading skills?

survival reading skills (letter, menu, bank statemtn), newspaper, printed words, phrases and sentences, paraphs and extended material

the preparation and transfer of food from the mouth to the esophagus

swallowing

What are the first symptoms of ALS?

swallowing difficulties dysarthria changes in nasal resonance laryngeal changes

What do you assess for structure of oral-motor evaluation?

symmetry, tone, tension, droopiness, expressiveness movments emotional expressions VP function nasal airflow with mirror during e coughing look for structural abnormalities of lips, tongue, teeth/dentures, gums, hard palate and velum

Describe Disorder of memory in TBI?

intact recognition memory but impaired recall for difficult tasks - impaired problem solving ability

Describe step 3?

integral stimulation followed by imitation without any simultaneous cues

Describe step 4?

integral stimulation with several successive productions without intervening stimuli or simultaneous cues

What are the approaches to treatment of AOS?

integral stimulation, tactile=kinesthetic, Prompt, melodic facilitation, and AAC

Define Anosognosia (nosoagnosia):?

lack of awareness or recognition of disease or disability

What is Aprosodia:?

lack of the ability to receive and express prosody*

What are the nonfluent aphasias characterized by?

limited, agrammatic effortful, haulting, and slow speech with impaired prosody.

Describe Non-Alzheimer Lobar Degeneration?

localized pathologies, to the size of infarction

What does vocal output include at stage IV?

longer utterances greater speed and precision of articulatory sequencing increased rhythmicity in speech

What are strategies to stimulate K?

look upwards and pretend to gargle. Pushing the tongue back or an r spoon.

What is Ballism?

looks like chorea but is wild flailing rare, involuntary movement disorder characterized by wild flailing, mostly of arms

What is postrual instability?

loss of ability to maintain an upright posture.

Describe stage 5 of ALS?

loss of functional speech due to profound weakness in patient with advanced bulbar ALS severe to profound dysarthria

describe alexia?

loss of previously acquired reading skills due to recent brain injury

What happens with coarticulation under the gestural theory?

thus, coarticulation occurs when these gestures overlap and interact with each other

What causes myasthenia gravis?

results from reduction of acetylcholine (excitatory nt) receptors at neuromuscular junction

pharynx general sensation

vagus via pharyngeal and superior laryngeal nerves, AND glossopharyngeal

What are the articulation characteristics of MS?

variable

What is the etiology of ballism?

vascular contralateral subthalamic nucleus

Describe the data analysis of McHenry 2003?

velocity duration the sum of 50 standard deviations for each rate condition was calculated and used to compute each participant's spatiotemporal index (STI)

What are the resonance characteristics of cerebellar dysarthria?

velopharyngeal functioning is usually intact

What will affect intraoral pressure?

velopharyngeal; lip closure; tongue elevation for alveolar stops,

What is important about Respiratory function?

ventilation, endotracheal tub- not appropriate to eat a all. Depend on the individual and the posture when it comes to tracheal tube. Ability to breathe when you have food in your mouth- brainstem injury or dementia, also, copd, congestive heart failure.

How is the falsetto exercise accomplished?

Ask client to slide up pitch scale as high as possible (high squeaky voice) hold for 5-10 seconds.

How can you assess for stridor?

Ask them if they make noise on inhalation. If paralyzed by midline, will have stridor Inadequate velopharyngeal

What are the assessments we use to diagnosis dysarthria?

Assessment of Intelligibility of Dysarthric Speech and Frenchay Dysarthria Assessment

What is assessment of awareness?

Assessment: answer questions A conscious patient may have levels of awareness that vary from stupor ("obtundation") to alertness. An alert patient can still be distractible or have difficulty with focusing attention.

Puree, Homogeneous, very cohesive, pudding-like, requires very little chewing ability

Give examples of NDD1?

Moist fine Cohesive, moist, semi-solid foods, requiring some chewing

Give examples of NDD2?

mechanical soft; Soft foods that require more chewing ability

Give examples of NDD3?

What does the effortful swallow do?

Gives you an oral hold because you hold for a second, prep your swallow, then swallow. Maneuver that can be performed indirectly then directly. Tell them you want to hear their swallow.

What are the pseudobulbar palsy characteristics in ALS?

Harshness and strain or struggle

Describe the Boston Diagnostic Aphasia Examination-Third Edition

Helpful in evaluating articulation, fluency, word fining, repetition, serial speech, grammar, paraphasias, auditory comp, oral reading, reading comp, wirting, and muscial skills. classifies into types.

Define phonetic derivation?

Modification of existing sound to produce difficult sound (e.g., use /t/ to get /s/)

What do we know about segmental error patterns?

More complex the sounds- fricatives, blends etc more errors===== both similar in where the breakdown will occur, but in frequency is different==== disarthria, consistent errors; apraxia- inconsistent- will not have 100% errors. Erors increase for fricatives, glides, hen clusters, but apraxia is never 100% production whereas dysarthria will be

What are the treatments for ataxic dysarhtria?

No evidence to support exercises for physiologic support General approach is behavioral

What is indirect therapy?

No food or liquid is given Exercise program Swallowing saliva

Describe medical intervention for AOS?

No specific pharmacological or surgical treatment for AOS, per se Augmentative communication, as indicated

Describe Movement disorder in TBI?

!Apathetic Syndrome (indifferent): Damage to the forward convexity !Akinetic Syndrome (not moving - stay in position you leave them in): Damage to the medial frontal area. !Disinhibition Syndrome: Damage to the inferior frontal area (also called the orbitofrontal area). This results in difficulty controlling impulses, including sexual impulses or fleeing (elopement - "I need to go now..." in the middle of therapy).

What is the Davis Definition

"Aphasia is a selective impairment of the cognitive system specialized for comprehending and formulating language, leaving other cognitive capacities relatively intact" (p. 15 in textbook)

What is Slow Information Processing?

"Mental slowness" has been identified as a fundamental consequence of head injury.

What is the basic principle of rehabilitation?

"The best therapy for any impaired activity, is the activity itself"

temporalis function

"snapping muscle" and tearing during chewing

Describe slowness of movements in spastic dysarthria?

(1 1/2 to 2 times slower than normal) unable to voluntarily speed up

Describe the key components Davis Definition (cognitive)

(a shorter version of the Darley model, omitting any reference to etiology, putting a greater focus on the impairment of the language processing system in cognitive terms):

How does race affect prognosis for recovery from stroke?

(not shown to matter)

Define Buccofacial apraxia?

(oral/nonverbal apraxia) inability to carry out facial movements on command (e.g. lick lips, whistle, cough or wink)

How do you assess emotions from frontal lobe syndromes?

- The Wisconsin Card Sorting Test has been thought to be sensitive to frontal lobe damage. - Some studies support this and others do not. - Apathetic Syndrome: Damage to the forward convexity. - Akinetic Syndrome: Damage to the medial frontal area. - Disinhibition Syndrome: Damage to the inferior frontal area (also called the orbitofrontal area). This results in difficulty controlling impulses, including sexual impulses or fleeing (elopement). - Minnesota Multiphasic Personality Inventory: Part of the Halstead-Reitan battery and is the most widely used personality measure.

What is Blephrospa?

- spasm of eyelid

How is naming thought to be accomplished?

---Correct naming indicates object recognition and that a person has knowledge of the object. -----Processing the stimulus, motor response for the task a.Identify the object as a member of a category whose stored representation provides a good match with the stimulus object b. When a category representation is achieved, the corresponding label is retrieved c. Recognition matches a percept to a 'structural description' already stored in LTM. d. The stored representation is called a 'recognition unit'. -----Object recognition activates a concept in the semantic system which points to the phonological output lexicon which guides speech production -----Semantic and lexical components -----Componential analysis: compares performances on a few tasks

What are the five general criteria for a diagnosis of dementia

-A change from previous level of cognitive function -Occurs without a disruption of consciousness -Is sufficient to influence daily functioning -Cannot be explained by situational stress -May result from a variety of conditions, some reversible

What are the swallowing characteristics in Huntington's? dysphagia is a frequent complaint

...

What are tics?

...

What are the principles of cognitive stimulation?

1. Elicit a variety of accurate responses in each system 2. number of items 3. Success Principle: and feedback upon error

What is an alternative tongue base retraction?

1. Look up toward the ceiling. 2. Pretend you have liquid in your mouth. 3. Gargle.

Disorders of oral preparatory phase include the following?

1. Problems in chewing food because of reduced range of lateral and vertical tongue movement 2. reduced range of lateral mandibular movement 3. reduced buccal tension 4. Poor alignment of the mandible and maxilla 5. Difficulty in forming and holding the bolus 6. abnormal holding of the bolus 7. slippage of food into the anterior and lateral sulcus 8. aspiration before swallow due to mostly weak lip closure 9. reduced tongue movement 10. inadequate tongue and buccal tension

for bolus control, 3 things required during mastication

1. adequate lip seal 2. lingual motility 3. buccal tension

disorders of this phase include the following problems which are generally caused by weak cricopharyngeus?

1. difficulty passing the bolus through the cricopharyngeus muscle and passed the seventh cervical vertebrae 2. backflow food from esophagus to pharynx 3. reduced esophageal contractions (which may be due to surgery, neurologic damage, or radiation therapy) 4. formation of diverticulum (a pouch that collects food) 5. development of tracheoesophageal fistula (a hole) 6. esophageal obstruction (by a tumor)

2 muscle layers of esophagus

1. inner circular layer 2. outer longitudinal layer

CN X muscles (8)

1. superior constrictor 2. middle constrictor 3. inferior constrictor 4. interarytenoid 5. lateral arytenoid 6. posterior arytenoid 7. thyroarytenoid 8. cricothyroid

Describe level 1 of MIT?

2-3 word length primarily vowels and bilabials no grammatical morphemes

when is dementia reversible?

20% of cases, due to treatable condtions such as metabolic distrubances, nutritional deficiences, chronic renal failure, persistent anemia, drug toxicity, lung and heart diseases.

What age corresponds to stage IV?

24-36 months

What age does stage 2 correspond to?

4-12 months

What are the stats on bilingualism

50-80% of world pop is bilingual, 45,00 per year aphasic,

Describe the subjects for McHenry 2003/

6 speakers with mild dysarthria (mostly flaccid) 6 speakers with moderate-to-severe dysarthria (mixed) 6 matched normal controls most etiologies were TBI

CDC Statistics of incidences on CVA

795,000 new cases reported each year; 1/4 are repeat 130,000 deaths 1 every 4 minutes 50% who survive have aphasia permanent disability to 300,000 people increase with advance age 2/3 are 65+

Describe th Blessed Dementia Scale?

8 every day activities and changes in 14 habits. Apretns, caregivers, and medical records are the source of info. Scores are for no impairment (below 4), mild (4-9) and moderate to severe 10+

What is the probable site of lesion for selective attention?

: connections between the thalamus and prefrontal cortex (called the thalamofrontal gating system) This manages selective or focused attention. These structures are vulnerable to forces of CHI (because of their location)

What is visual agnosia?

An object can be seen but is unfamiliar

what do lip exercises help with?

Anterior lip closure/ bolus control, straw drinking. Intraoral pressure for smack your lips together.

What do lesions of the cerbellum or cerebellar tracts cause?

Ataxic dysarthria

What causes pseudobulbar affect?

Bilateral cortical damage can affect inhibition. Boca's aphasia= parlized arm is up and close to body, let is super extended.

What are two tests that can be used with bilinguals?

Bilingual Aphasia Test (BAT) and multilingual Aphasia Examination-Revised (MAE)

Describe Standardized testing may be used

Both screening and diagnostic aphasia tests are available. Most screening tests include items to assess verbal expression, auditory comprehension, repetition, naming, automatic speech (routine and overlearned speech production as reciting the alphabet), and limited reading and writing. Some diagnostic tests are designed to assess and classify aphasias into specific types and other tests assess various behaviors of interest and do not attempt a classification.

what is the most common cause of aphasia

CVA stroke

What are the causes of aphasia

CVAs TUMOR Focal Cortical Atrophy: Primary progressive aphasia (PPA) and Non-Alzheimer lobar degeneration

Describe aphasia as a management decision for AOS?

Can affect the ability to comprehend spoken and written stimuli used during treatment May be difficult to distinguish aphasic from apraxia errors during treatment Aphasia may be so severe that verbal communication would not be functional even if motor speech programming were intact

How can you measure respiratory function?

Can measure with a straw in a glass with cm markings- put it 3m in, if they can do that. Parkinson"s low volume because of poor self monitoring

What is Gilles de la Tourette's?

Childhood onset disease Uncontrolled vocalizations

Cognitive rehabilitation

Clinicians train such components as attention, Visual processing, and memory, which may not result in improved communication. Attempts to improve memory, reasoning skills, and other cognitive functions may be better integrated with communication treatment

Describe syllable boundary?

Clusters within syllables tend to be more difficult than cluster across boundaries (e.g., stake vs. mistake)

List the functional assessment tools?

Communication Abilities in Daily Living Second Edition (CADLE-2) The Burden of Stroke Scale (BOSS), Communicative Effectiveness Index (CETI), Functional Independence Measure (FIM), Functional Assessment of Communication Skills for Adults (FACS), Amsterdam-Nijmegen Everyday Language Test (ANELT).

Give an example of context/ no contet for intelligibility?

Context- 60% intelligible, transcription 20% remember the context; may get anive from experienced.

What is the purpose of compensatory treatment?

Control the flow of food and eliminate the patient's symptoms- however do not change the physiology

What is important for the respiratory phase?

Coordination of respiration and swallowing Nasal cannula only breathe in and out through nose- measure inspiration and expiration= are they swallowing and taking deep breath in. Interested to know if they have tendency to breathe in when they are done swallowing= that will show us that they will breath in any of the penetrable material. Supraglottal= swallow then cough.

What is the probable site of lesion for arousal?

Cortical arousal to any environmental stimulus depends on the reticular activating system in the brain stem. Damage to this system is thought to cause a coma.

Describe description?

DAB dimensions are descriptors features that may distinguish one type of dysarthria from another

Why does hypotonia occur with flaccid dysarthria?

Damage to LMNs (or to Ia afferents that carry sensory information to the alpha neurons) causes a decrease in gamma efferent discharge

Who is DAB?

Darley, Aronson, & Brown

What is awareness of bolus swallow initiation?

Deep pressure to elicit a swallow.

guards around the dish so there is a lip. Good for someone with right or left visual. As they are coming over, the built up part will allow it to stay on the plate.

Describe Cup with two handles?

Delayed initiation of swallow: slow down and more time to initiate the swallow Allow for more time; and also use more muscle to pass it through and recruiting more muscle power

Describe Honey thick liquids?

Load the spoon and the metal bar scoop the food off. Pushes it off the spoon or place it posteriorly. Or with labial closure.

Describe Mirror?

Good for people who do have good closure; have hypoglossal damage, tongue cancer.

Describe Nectar thick?

is helpful for labial spillage and for pocketing.

Describe Placemats?

increase vocal cord adduction

Describe the vocal cord injection?

Define apraxia according to DAB?

Disorder of speech resulting from neurologic impairment affecting the motor programming of speech

What are the early symptoms of progressive supranuclear palsy?

Dysarthria and dysphagia combination of spastic, hypokinetic and/or ataxic types

What are the errors most often seen in AOS?

Errors are primarily substitutions, additions, repetitions, and prolongations. Errors of simplification, such as distortions and omissions, are relatively less frequent. Majority of errors are close approximations of the target sounds. Errors of place > errors of manner > errors of voicing.

Describe baseline data?

Establish intelligibility, presence and degree of associated deficits Essential to acquire a careful inventory of articulatory errors as well as the factors that influence/facilitate the accuracy and adequacy of speech Typical patterns can help to establish therapy hierarchy

Describe the Functional Asssessment of Communication Skills for Adults

FACS developed for ASHA. rates social communication, communication of basic needs, reading, writing, and number concepts and daily planning. Clinicians and family can

Describe FOCUSED caregiver communication program

Face to face communication • Orient to topic • Continuity of topic • Unstick blocks • Structured questions • Exchange of turns • Direct short sentences

Describe structure of augmented feedback?

Feedback type (knowledge of results vs. knowledge of performance), feedback frequency (high and low), and Feedback Timing (immediate vs. delayed).

What is synonymous with LMN?

Final common pathway

Describe the behavioral approach to ataxic dysarthria?

Goal is to improve/compensate for motor control and coordination Force of movement, gauging and timing movement- hard to address them individually.

What is important to remember for VC adduction?

Good exercise but don't want to create vocal fold damage. Vocal cold adduction, sustaining, respiratory support.

Who is is the super-supraglottic swallow good for?

Good for someone with a tracheostomy tube, take a Cough clears anything that may have been pentrating and ensure. Good for someone with silent aspiration

What was the stimuli in the Tjaden and Wilding study?

Grandfather passage

Describe beyond stage IV?

High-level systems of fine movement control refine speech production above the level of movement control necessary for feeding.

Describe stage III?

Higher levels of cortical control and sensory integration provide further modification of feeding movements. Previously meaningless oral movements become associated with verbal language.

tuna fish, egg salad, chopped fruits/vegetables, chopped meat with gravy

How can you prepare NDD2?

stew, tender meat, cooked vegetables, bread without crust

How can you prepare NDD3?

What is parkinson's caused by?

Idiopathic (typically) degenerative changes in substantia nigra causing deficiency in the neurotransmitter dopamine

What techniques should be used?

If the goal of therapy is to change speech, techniques should be designed for that purpose

What are the goals of treatment?

Improve ability to eat and swallow safely Optimize nutrition and hydration status Maximize swallow function

What is the goal of range of motion tongue exercises?

Improve oral transit

What is the goal of thermal tactile stimulation?

Improve speed of triggering pharyngeal swallow

Describe stability and mobility?

In infancy, neurological control for postural stability is not present Initial movements may be random, undirected and uncontrolled. As proximal portions of the body become more stabilized, movement becomes more directed and skillful.

Why is DAB a useful paradigm?

It helped clinicians think about differential diagnosis in ways that contribute to neurologic localization. provided the framework for a substantial number of clinical descriptive studies of the dysarthrias associated with specific diseases. tied to hypotheses about underlying pathophysiology, so it hasprovided a framework for clinicians' thinking about management of underlying impairment. offered a vocabulary and language for describing and communicating about the dysarthrias. DAB's labels for the deviant speech characteristics associated with dysarthria can assist in the description of abnormal speech.

What is a consideration for involuntary exercises?

Just because they can do something reflexively, it doesn't mean they can do it voluntarily Some apraxia in speech with adults will see this= apraxia, use automatic to shape to voluntary, but remember they do not have weakness.

What is the effect of chorea?

Largely involuntary movements that disrupt voluntary movements

Describe Thalamotomy?

Lesion placed in ventrolateral nucleus of thalamus Intended to decrease tremor May make dysarthria symptoms worse

How would you assess Quality of life?

Life participation: extent of an aphasic individual's involvement in his or her life :Quality of life- can use the psychosocial well-being index.

Oral cancer patients Neurological patients (bilateral hypoglossal paralysis) Velopharyngeal deficits

List the intraoral prosthetics?

What is the most prominent affect of ALS?

Main type where the respiratory system is affected. Nerves that innervate the muscles- wind up on ventilators.

What are the lip resistance exercises for maintaining smile?

Maintain position while clinician attempts to move mouth into pucker

What adjustments must the SLP make in tx given Medicare mandates?

Make language Tx maximally functional, Start compensatory strategies quickly, Train family members to do tx, Get volunteers to facilitate communication in activities of daily living (ADL).

What else if affected with progresive supranuclear palsy?

May be personality and cognitive changes associated with frontal lobe dysfunction

What are the treatment techniques for spastic dysarthria?

May benefit from decreasing tension and/or stretching exercises, although

Describe management of pseudobulbar palsy?

May benefit from pharmaceutical management (amitriptyline/Elavil) for "emotional lability" Addressing postural triggers may be helpful

What is important about prognosis?

May have a profound dysphagia and may not be able to swallow. Think about the realistic goals.

What will bilateral cortical damage do?

May resemble symptoms of multiple LMN damage = pseudobulbar

Describe word complexity?

More segments/syllable or syllables/word = more errors

~Describe acceleration-deceleration brain injuries

More serious than non-acceleration injuries -the head is set into motion by physical forces. When the head begins to move, the brain inside is still static. Soon, the brain begins to move. When the head stops moving, the brain keeps moving inside the skull and thus strikes the skull on the opposite side of initial impact. The moving brain is lacerated or torn because of the bony projections on the base of the skull. -the acceleration-deceleration movement of the head in an automobile accident is an example

What is the treatment of resonance in flaccid dysarthria?

Most common in this population Best candidates for palatal lift prosthesis and pharyngeal flap surgery

Which will be used?

Most will do a combo of direct and indirect.

Describe Tumors

Neoplasms abnormal mass of tissue caused by an increased rate in the reproduction of cells Can be benign or malignant

Define apraxia according to Duffy 2013?

Neurologic speech disorder that reflects an impaired capacity to plan/program sensorimotor commands necessary for directing movements that result in phonetically and prosodically normal speech

What flaccid disorders can be treated?

Neurologically based resonance disorders are not easily treated with therapy. Could have velar elevation during swallowing but not achieve during speech. Use behavioral therapies if it is an intermittent problem or

What is stage 1 of ALS characterized by?

No detectable speech disorder

Describe Type of Head Injury in regard to prognosis for recovery?

Non-penetrating (closed) and penetrating (closed) Penetrating= clinical aphasia after 2 months post-onset Non-penetrating: language areas remained aphasic (more recovered) Rapid and large recovery for CHI (not focal)

Describe Nonprogressive Dementias

Nonprogressive- due to injury to the brain or infection Vascular Dementia (including multiple infarcts) Any location Arteriosclerotic reductions of blood supply (accumulated small ischemic strokes) Herpes simplex viral encephalitis (HSVE) Medial temporal areas extending into orbitofrontal regions; usually bilateral Infection causing acute necrosis, edema and hemorrhage; sometimes evolves to coma in 2-3 days

Describe Rate of Intelligible Speech (IWPM)?

Number of correctly transcribed words/total duration

Describe Rate of Unintelligible Speech (UWPM)?

Number of unintelligible words/total duration (optional)

Describe Intelligibility (%)?

Number of words transcribed correctly/total number of words (220)

What does the IOPI give us?

Objective measurement of tongue and lip strength Therapeutic exercise program

What is stage 2 of ALS characterized by?

Obvious speech disorder with intelligible speech

Describe Age of the patient in regard to prognosis for recovery?

Older patients have a higher mortality rate and poorer prognosis for recovered functions than younger patients.

Where are the electrodes placed?

On the facial muscles and on the strap muscles--- Vital stim has to be placed during swallowing and in exercises= actively working with individual

What are the symptoms of lmn damage or disease?

Paralysis, hyptonia, hyporeflexia, fasiculations

What is a hypokinetic dysarthria?

Parkinson's disease

What are the characteristics of anomic aphasia?

Pervasive word finding no impairment of pointing to objects fluent speech (normal syntax( vague, nonspecific words verbal paraphasia circumlocutions goo auditory comprehension intact repetition unimparied articulation normal oral reading, reading comprehension, and writing skills Amnesic aphasia, mildest form better retrieving verbs than nouns Their deficits show up on Token Tests and reading assessments due to their trouble with content-bearing words.

What causes the resonance symptoms of flaccid dysarthria?

Pharyngeal branch of the vagus nerve Nasality is most frequently seen in flaccid rather than spastic

What are the kinds of phonatory symptoms?

Phonatory problems may be mild or severe, resulting in problems as minor as voicing errors or as major as aphonia.

What may phonatory function indicate?

Phonatory symptoms may present as early signs in some dysarthrias (e.g., Parkinson's and Myasthenia Gravis). Type of phonatory symptoms may give clues to underlying neuropathology

How is the Mendelsohn maneuver performed?

Place your fingers lightly on your neck to feel how the larynx/voice box lifts as you swallow. You will notice that at the very peak of the swallow, the larynx is lifted to its highest point in the neck, and when the swallow is finished, the larynx falls down again. 1. Swallow with your fingers lightly on your larynx. 2. When you feel your larynx get to its highest point, hold it up by pushing your tongue hard against the roof of your mouth and keeping it there. 3. Keep the larynx lifted for ________ seconds

Describe rigid imposition of rate?

Point to first letter of each word on alphabet board while speaking Decreases rate and increases "comprehensibility" Use of pacing board Syllabic approach

What are issues that exist with bilinguals?

Proficiency in second language; age of learning; manner of learning; context of learning; affective factors such as cultural attitudes toward a language; linguistic relationship

What is the profile for LMN?

Profile for lmn leasions; can vary in regard to what is affected. Can be just the lip or just the tongue and velum.

What does PROMPT stand for?

Prompts for Restructuring Oral Muscular Phonetic Targets

What are the techniques for improving 'comprehensibility' for individuals with severely compromised intelligibility?

Provide listener with context Don't shift topics abruptly Use turn-taking signals Get the listener's attention Use complete sentences Use predictable types of sentences Use predictable wording Rephrase your message

What are activities designed to increase?

Ps Vowel duration Loudness Breath group duration/words per breath group

When Tx is aimed at disability and handicap (vs. impairment)?

RECOVERY & COMPENSATORY BEHAVIORS TO IMPROVE QUALITY OF LIFE: Indicate Basic needs Produce a RELIABLE yes/no impairment auditory comprehension (present a S w/ pix options) give an auditory sentence- cross modality word-finding during speaking (show pictures, speak) show some pics and ask to name or talk to them about something reading comprehension (present a S w/ pix options) word-finding during writing (show pictures, write) may ask person to write names or write a paragraph

Describe race in regard to prognosis for recovery?

Race and gender of the patient are not important in recovery

What is part II of the shaker exercise?

Raise your head up and forward and look at your feet thirty times. Do not sustain these head lifts or raise your shoulders.

will the patient be returned to normal?

Rare to get back to premorbid status

What do we want to do for spastic?

Reduce spasticity; reduce rigidity. Work with flaccid dysarthria Do not do strengthening with myasthenia gravis, do not do.

Describe speed-accuracy trade off?

Reduced rate nearly always emphasized early in treatment Responses should be less automatic, more conscious Can increase rate when accuracy improves

Describe the considerations for the Evaluation of bilinguals?

Relative ability in each language Detailed history Situations and purposes for which each language was used (ppl may be bilingual but have academic proficiency in one lang. but only social proficiency in other) o People with whom each language was used (may only use L1 with grandparents) o Situations and people when in a monolingual mode (when to go in which mode) o Situations and people for which/whom pt goes into a bilingual mode o Amount and kind of mixing when in the bilingual mode o Translational mode (between speakers of l1 and l2 you may need to translate for them.) first assessment functional, second more detailed interpreter may avoid bilingual tests that are translations with no standarization of the target population

What is lst big?

Relatively new part of program whose goal is to improve movement of the body in general

What is important to remember for cerebellar damage?

Remember cerebellum is feedforward (duffy says feedback)

What is important about diagnosis?

Remember if it is progressive or degenerative, if there is a time of onset, cognitive function,

How frequently should vocal cord adduction be performed?

Repeat 3 repetitions/5-10 times a day

How frequently does range of motion tongue exercises need to be repeated?

Repeat cycle 5-10 times in one session To get a one sided weakness to the middle, push it to the side.

How are posterior lingual elevation tasks completed?

Repeat these words ending with "k." Make a hard, forceful "k" each time you say a word. Tick-tock.

How is tongue base retraction exercise performed?

Repeat these words ending with "l." Hold "l" each time you say a word.

Outline the Aphasia Assessment

Repetition Skills Naming Skills Sentences and Discourse Production Speech Fluency Functional Communication Skills Auditory Comprehension of Spoken Language Comprehension of Single Words Comprehensions of Sentences, paragraphs, and discourse reading skills writing skills gestures and pantomime automated speech and singing bilingual speakers with aphasia

Describe "Reality Orientation"

Repetitive presentation of the date, time, and place which are posted in the patient's rooms, rehearsed with hospital staff and rehearsed again in group meetings

What does development of skill and precision require?

Requires separation of movements

What are the findings on IOPI?

Research to support in swallowing and in speech production. 45minutes 5x times per week. Good as an assessment tool. Bring to alveolar ridge to increase strength

What are the neurologic characteristics of hypokinesia?

Resting tremor, rigidity, bradykinesia, akinesia/hpokinesia, masked facies, stooped psture, dementia, festination

How can cerebellar speech be described?

Scanning speech- all the same syllable length "slurred speech" Drunken sounding

What are the tasks of the ADS?

Sentences varying from 5-15 words, speaking rate,intelligible WPM, single words

What are the three categories of CP spastic syndromes?

Spastic hemiplegia/hemiparesis, spastic diplegia (little's disease), spastic quadriplegia

How is the masako maneuver performed?

Stick your tongue out and lightly hold between your teeth. 2. Swallow, while keeping you tongue protruded.

Describe Conversation as Therapy?

The SLP sets out to help a patient transfer compensatory strategies such as drawing and gesture to a conversational interaction Should use scaffolded conversations, in which the exchange of messages is supported by providing cues or facilitators with the flow of the interaction (e.g., we may quickly write a word that a participant was gesturing)

Describe Functional Memory in TBI?

The categories were speech, reading and writing, faces and places, actions, and learning new things. The results showed the instability of memory in the first few months after injury and indicate that formal test may not be predictive of everyday memory, at least, in the way that everyday memory was assessed in this study.

What is a hematoma?

The hematoma is a (blood clot) rapidly expanding mass that displaces adjacent structures. It is caused by naturally weakened blood vessel walls or by tearing of arteries during TBI.

Define agnosia?

The impairment of the ability to recognize a stimulus even though sensory transmission is intact

What is Deep dyslexia?

The reverse of surface dyslexia in that nonwords and function words are harder to read than content words. Additionally, real words are read more accurately than nonwords. Lastly, concrete words are more accurate than abstract words. Semantic, visual, & derivational errors are made. Mainly semantic errors are made such as "coast" for seashore; "tear" for crying. An example of a visual error is reading "camping" for campaign. An example of a derivational error is reading "strange" for stranger; "territorial" for territory.

Describe The symptoms of agrammatism

The simplification of sentence (S) structure. -Don't use clauses, don't embed phrases with modifiers,-=they sequence ideas with a series of structures. Structural errors such as illegal word order. Reverse noun phrase 40% of the time.

What is phonological dyslexia?

There is difficulty producing nonwords and familiarity is a strong factor. Real words are read more accurately than nonwords

Describe A brief bedside evaluation can be completed

This can include yes/no questions, pointing to things, naming and describing things, counting or reciting the days of the week and repetition of words, phrases and sentences. ex: point to window, is california a state in canada, brief reading and writing sample

What are modifications?

To target one side at a time, put it on one side. Important for the patient to pull it themselves. Will help with the reduced seal.

What are tests of auditory comprehension?

Token Test and Revised Token Test, Auditory Comprehension Tests for Sentences, Functional Auditory Comprehension Task

What is the treatment of articulation in flaccid dysarthria?

Tongue and lip weakness Might benefit from bite block Strength training may be indicated, but uncertain efficacy For patients with Myasthenia Gravis, conservation of strength should be the focus of treatment

What are the voice characteristics caused by in flaccid dysarthria?

Unilateral or bilateral vocal cord paralysis depend on the position of paralyzed cord(s)

What are the EXCEPTIONAL APHASIAS

Unusual, questionable with aphasia definition, crossed aphasia and subcortical aphasia

Define phonetic placement?

Use any and every model to achieve correct placement

Describe the purpose of VF fillers and injections?

Use fillers and injections to increase the mass of the cord so the mobile cord meets it

What is direct therapy?

Use of food and liquid during treatment Training in compensatory techniques

What are the lip resistance exercises for maintaining closure?

Use string/dental floss with button behind lips in front of teeth Hold tongue blade between lips (easier the more tongue blades you use

sequence of events from CNS to cranial nerves - step 5 - what nerves begins the pharyngeal swallowing response?

Vagus

Why is this important?

Vowels before voiced stops are longer than voiceless

What questions are asked for stimulability?

Which symptoms are amenable to change? It is frustrating for both patient and therapist to work on a symptom that is not likely to change.

Most difficult to control Best used for: Reduced tongue base retraction Reduced pharyngeal wall contraction Reduced laryngeal elevation Reduced UES opening

Who cant use thin liquids?

Avoid very hard, sticky or crunchy foods Size of nickel or a quarter; all cooked. Rice isn't usually allowed, risotto or orzo is possible. Tuna without a crust.

Who is NDD3 good for?

Cant be used for those with oral spillage due to paralysis, spillage, lingual elevation, vp closure, posterior spillage, delayed swallow,

Who is best for thin liquids?

Regular food without restrictions that is precut for individuals with motoric impairments

Who is bite-cut regular good for?

Coats and drips off a spoon, similar to unset gelatin Best used for Reduced tongue coordination Delayed initiation of the swallow Reduced laryngeal closure (reduced laryngeal elevation and excursion)

Who is nectar thick best used for?

What is the next step?

With increase success the clinician may advance to a smaller more difficult manipulative

What are problems associated with cp?

\30-70% have limitations in intellectual and cognitive functioning various ocular abnormalities 30%+ experience seizure disorders bowel and bladder control may be impaired orthopedic complications occur in response to chronic muscle imbalances and involuntary movements

What is thrombos

a collection of blood material (atherosclerotic plateles) that blocks the flow of blood

What kind of dysarthria is ms?

a mixed spastic-ataxic dysarthria

What kind of disorder is apraxia of speech?

a phonetic-motoric disorder rather than a linguistically-based disorder

Given an example of a cognitive defintion

a selective impairment of the cognitive system specialized for comprehending and formulating language, leaving other cogntive capacities relatively intact.

Describe Personality disorder in TBI?

a. Aggression b. Mood dysregulation (e.g., moodiness, irritability, "mood swings") c. Apathy = indifference, or the suppression of emotions such as concern, excitement, and motivation Agnosia: unaware of cognitive, memory or personality change Amnesia d. retrograde amnesia: forgetting memories acquired before the injury (i.e. remote memory) e. anterograde amnesia: forgetting memories acquired after the injury (i.e. recent memory)

Describe Scripted Dialogues ?

a. Conversational coaching involves the clinician providing a patient with a short script that is slightly too difficult for the patient to produce b. The script incorporates communicative strategies that were previously trained i. These strategies include conversational management (e.g., such as asking a listener to slow down)

What is the purpose of functional stimulation?

a. Functional stimulation begins with the goal of maximizing the likelihood of stimulus and response generalization. This can be achieved by training sufficient exemplars (e.g., training a wide variety of words within a semantic category; instead of naming 5 foods, a patient practices naming 20 or 30 foods), training a behavior in a variety of conditions (e.g., different settings), selecting content that is personally relevant, and choose activities that are common in a patient's daily life. Thus, the purpose is to maximize generalization and teach communicative skills relevant to the person's everyday life.

Describe Executive dysfunctioni in TBI?

a. Initiation or drive (e.g., does not go to the grocery store when refrigerator is empty b. Disinhibition - difficulty controlling impulses (e.g., shops impulsively) c. Task persistence: maintaining behavior due to increased distractibility (e.g., does not get all items on shopping list) d. Organization (e.g., does not use aisle headings) e. Generative thinking: creativity and flexibility (e.g., does not think of a substitute for unavailable item) f. Awareness: self-monitoring and modification (e.g., is not concerned about a need for groceries)

What are the three general diagnostic categories (Hagen, 1981) has established for Traumatic Brain Injury?

a. residual cognitive impairment without language dysfunction b. disorganized language secondary to cognitive impairments c. predominant language-specific disorder, (this is aphasia)

what are the characteristics of dementia?

acquired neurological syndrome characterized by progressive deterioration in intellectual fucntions, judgment, thinking, visuospatial skills, contructional abilities, language memory, emotion, and behavior.

What are ways of looking at treatment efficacy?

acquisition of targeted behavior long term retention (after treatment is terminated) generalization to untrained exemplars of trained behaviors as well as to untrained (i.e., novel) behaviors

What are the treatments for verbal expression/ expanded utterances

action filled pictures and sicourse, daily activiies (cooking) and speical events (planning a vacation)

Describe VP dysfunction in dysarthria?

adequate palatal tissue for achieving closure slowness, weakness and incoordination of palatal movements

How do you increase respiratory flexibility?

adjusting lung volume levels levels of training maximizing naturalness

What is the etiology of tourettes?

affects mostly boys onset between 2 and 15 years etiology unknown (some speculation about increased dopamine activity)

Define apraxia?

an acquired disorder caused by damage to specific areas of the cerebrum, characterized by loss of the ability to execute or carry out learned purposeful movements, but not caused by incoordination, sensory loss, or deficits of comprehension.

Define Visual Agnosia?

an object can be seen but it is unfamiliar (i.e., the person cannot recognize the object) bilateral occipital lobe damage or posterior parietal lobe damage

the palatoglossus makes up the

anterior faucial pillars

Name some standardized screening tests?

aphasia langauge performance scale (ALPS), Sklar Aphasia Scale (SAS), Bedside Evaluation Screening Test (Best-2), Aphasia Screening Test-Second Edition (AST-2), Quick Assessment for Aphasia

What should apraxia not be confused with?

aphasia or an inability to produce and/or comprehend language or the lack of desire to carry out an action,

sequence of events from CNS to cranial nerves - step 6

apneic pause accompanies swallowing

What are the neurological characteristics of cerebellar damage?

ataxia, dysmetria, dysdiadochokinesia, rebound, hyptotonia, tremor, Nystagmus, positive Romberg sign, pendular reflexes, slowness of movement.

Describe an infant at 8/9 months?

baby moves food from center of mouth to sides swallow may be triggered even as jaw and tongue tip are elevated jaw and tongue movement begin to separate contact of tongue tip and alveolar ridge are intensified when jaw-tongue contact is removed

Describe Functional maintenance therapy (FMT)

based on a functional maintenance plan (FMP). FMP consists of evaluation and a short-term diagnostic treatment program for patients who demonstrate a potential for improvement. o SLP's prescribe the treatment which is carried out by caregivers. o Educating caregivers may be reimbursable by Medicare

What is Duffy's position on nonspeech activities?

because articulators use only a fraction of maximum force for speech (tongue 10%, lips 30%, jaw 2%), non-speech strengthening exercises should be used only if it can be shown that weakness is contributing to the articulation and/or intelligibility problem (Duffy)

How is loudness increased?

behavioral management and prosthetic management

location of auerbach's plexus

between circular muscle layer and outer longitudinal muscle layer

location of meissner's plexus

between muscularis mucosa and circular muscle layer

Describe vascular dementia?

bilateral cortical, subcortical or mixed damage. More often in African Americans, chronic hypertenia. Sudden onset

Describe Face Recognition in RHD?

bilateral or R-pareiental lesions, may be due to slowed buffer search systems

What age does stage 1 of oral motor development correspond to?

birth-three months

What happens with muscle force in fundamental cerebellar deficit?

cerebellar damage might slow, or make discontinuous, the normally precise muscle forces

Describe stage 3 of ALS?

changes in rate, articulation and resonance are evident moderate to severe dysarthria

What is inflectional paralexia?

changes structure not grammatical catgory- plant for plants; running for run

What is pseudobulbar affect?

characterized by involuntary crying or uncontrollable episodes of crying and/or laughing, or other emotional displays- inappropriate and not intentional or emotional response.

masseter function

chewing, including rotary movement

What are the phonation speech characteristics of Flaccid dysarthria?

classic symptoms include breathiness, inspiratory stridor, short phrases, monotony of pitch and loudness

Describe Disorders of memory & executive control

combine as a dysexecutive memory impairment. a. The problematic pattern of deficit occurs as intact recognition memory but impaired recall on tasks equated for difficulty. b. Scrutiny of recall tasks indicated pts have difficulty implementing retrieval strategies, which is considered to be one job of the executive system.

What is decomposition of movement?

complex motor act is broken into component parts

Describe words vs. sentences?

contextual cues may assist intelligibility sentence production may be too taxing for the more severely impaired

What controls rhythmicity of swallowing?

control is at level of brainstem

Describe the results of McHenry 2003?

controls demonstrated least variability across conditions (i.e., lowest STI) both dysarthria groups were least variable in stretched condition and most variable in fast condition moderate to severe group was most variable moderate-to-severe group could not get much faster suggests that they are already speaking at their physiological limit subjects with the highest STI values in the habitual condition showed the most dramatic reductions in STI at reduced rates

What do you assess for the Larynx?

cough stridor phrase length

Describe the success principle for cognitive stimulation?

d. Start with what the patient can do correctly at the 60-80% level (so that you do not set them up for failure). e. You do not want to frustrate the patient. Have the patient experience success which gives him/her a sense of accomplishment. f. This ensures practicing normal language processing. g. If the patient makes 30% or more errors, make the task easier (give them feedback..but not too much because you don't want to bog them down; give them general encouragement but do not need to reinforce every one)

What is Diplopia?

double vision

Describe vowel prolongation tasks?

duration amplitude pitch extraneous movements nasality

What is the gestural theory?

each segment is represented by an articulatory gesture that comprises a set of instructions for the realization of certain features gestures for segments are relatively stable across contexts, but extend beyond the time when their acoustic manifestations are apparent

CN VII

facial

CN IX

glossopharyngeal

stylopharyngeus

glossopharyngeal

Describe the Bilingual Aphasia Test

help asses aphasia in serveral languages

What are the phonation characteristics of MS?

impaired loudness and pitch control harshness

Define Apraxia of gait?

leg coordination

What is athetosis?

major subcategory of cerbral palsy similar to dystonia in adults

the mandibular sling is made up of which muscles?

masseter and medial pterygoid

Define Integral?

maximal cueing, maximal prompting.

Describe Level 3 of MIT?

maximum syntactic, phonological and morphological complexity

What is essential tremor?

may affect many body parts or just the larynx (extrinsic and intrinsic musculature)

Describe the 3 prosodic aspects of spoken language?

melodic line - 'intoned' speech tempo and rhythm - lengthened and exaggerated stress pattern - changed to a pattern of relatively equal stress

Gender/ race stats on CVA?

men are more prone women experience more due to longetivity African American men and women higher incidence South Asians high incidence Hispanics and African Americans earlier age 87% are ischemic Minorities more prone to hemorrhagic

Define Habit strength/ Rule of Pitres?

most frequently used language should be less impaired and will recover first because of the "habit" strength.

Describe Global Aphasia

most severe form of nonfluent extensive lesions through the perisylvian region (broca's and wernickes) Severe Depression of language functions in all modalities widespread destruction of the frontotemporoparietal regions MCA independent verbal and nonverbal apraxia right-sided paresis or paralysis, right sided sensory loss, neglect of the left side of body

What are the types of definitions for aphasia?

nontypolgoical and typological

Describe Actions in regard to functional memory?

o Forgetting to do something routine o Starting something, the forgetting what you were doing

What is essential organic voice tremor?

occurs in 20% of cases of essential tremor voice may evidence regular tremor of alternating pitch and loudness may be absent at rest severe cases may experience complete voice stoppages

sequence of events from CNS to cranial nerves - step 5

once cranial nerves are stimulated, the entire pharyngeal swallowing response is generated

describe dementia associated with parkinson's

only about 35-55% of individuals basal ganglia and brainstem degeneration presence of abnormal sturctures frontal lobe

What are the jaw resistance exercises for treatment of articulation?

open/lateralize/protrude jaw against hand placed under chin, on side or in front of jaw

Define motor sequencing?

ordering the individual gestures which make up the whole motor plan and coordinating them with each other including transitioning from one gesture to the next

voluntary swallows require

oropharyngeal sensory input

outer layer of muscle of esophagus

outer longitudinal layer

What is rigidity?

passive movement induces involuntary contraction of muscle being stretched

What are the DAB clusters for Flaccid dysarthria?

phonatory incompetence resonatopry incompetence phonatory-prosodic insufficiency

What is Parasthesias?

pins and needles

What are the 3-stage/process division of the motor system according to Van der Merwe?

planning programming execution

What is the treamtnet of other writing skills?

pointing to the correct printed letter the clinician names, pointing to printed words and phrases, saying the sound of a printed letter, saying a printed word shown, tracing printed letter, cpying printed words and phrases, speling words correctly, writing to dictation, spontanous writing of phrases and sentces, spontaneous exptedn writing

Describe assessment of Auditory comprehension problems?

possibly more pronounced for a complex or abstract material; both clinical examinations and selected standardized assessment tools may be helpful in assessing auditory comprehension deficits

What do you assess for Respiration?

posture/patterns breath support phrase length

Describe step 5?

presentation of written stimuli without auditory or visual cues, followed by patient response

How do you improve laryngeal coordination?

respiratory laryngeal timing and voicing distinction

Describe step 8?

response is elicited in an appropriate role-playing situation

What were the two categories for the hierarchy the rate control techniques were put into?

rigid imposition of rate and rhythmic cueing.

List 3 reflexes an infant has in stage 1?

rooting reaction suckle-swallow reflex reflexive closure of vocal folds

swallowing requires

sensation

What does Brady mean?

slow

What is arousal?

state of consciousness; primitive wakefulness

What are the nonspeech characteristics of hyperkinesias?

striking features are most evident at rest or during attempts to maintain steady facial postures continuous, arrhythmic, slow, writhing movements that cease during sleep may be characterized by blephrospasm, facial grimacing, tongue protrusion and other involuntary movements of speech musculature (oromandibular dystonia) in some cases, dystonia may be triggered by attempt to speak

What have studies found in regard to the overlap?

studies have demonstrated that there is less overlap when syllables are stressed neutral syllables are added speaking rate is reduced

cricothyroid function

tenses or lengthens vocal folds

thyroarytenoid function

tenses or shortens vocal folds

What is Programmed Stimulation?

the plan for progressing toward a goal (e.g. to produce a complete Sentence) is the program. -A plan may have many goals. Manuals of aphasia therapy provide samples of goals and programs. -A small step is formed by changing only one variable in the task. -Fading involves removing supplemented cues from the stimulus. -When do we move to the next step? After 70-95%

What is the classification system used with dysarthria based on?

the site of lesion common speech perceptual characteristics

Define Alternating aphasia?

this is rare & questionable...BS accd to Dr.K: expression impaired in different language each day.

CN V

trigeminal

What are the tongue resistance exercises for treatment of articulation?

use tongue blade to provide resistance against which patient moves tongue forward, laterally and/or upward.

Describe production of monosyllabic CVCs?

uses real and nonsense words place, manner and voicing contrasts presented auditory and visual prompts faded visual stimuli introduced

CN X

vagus

superior, middle, inferior constrictors

vagus

What is treatment of aphasia focued on

verbal expression, auditory comprehension, reading, writing, nonverbal communication.

Describe clinical goals for velopharyngeal dysfunction?

verify presence of VP dysfunction describe deficit in terms of severity and consistency determine appropriate intervention strategy

What are the respiration deficits for cerebellar damage?

very affected often need for ventilation

What are the neurologic characteristics of spastic syndromes?

weakness movement velocity deficits hypertonic trunk muscles difficulty with sequential movement increased muscle tone with hyperactive stretch reflexes and +Babinski persistence of primitive reflexes distal portions of arms and legs usually more affected than trunk speech characteristics

What is mild cogntive impairment (MC()

when the problem is both mild and limited to a single domain such as memory.

What are the types of dysarthria?

• Flaccid dysarthria • Spastic dysarthria • Ataxic dysarthria • Hypokinetic dysarthria • Hyperkinetic dysarthrias • Mixed dysarthrias

Describe Metaphor Comprehension in RHD?

• Is usually worse in RHD than in LHD • Relied more on denotation more than connotation • Able to accces non-literal menaings

salpingopharyngeus

vagus and accessory

Describe the tasks for McHenry 2003?

"Buy Bobby a puppy" repeated in 20 separate utterances in 4 conditions (habitual, fast, breaks between words, stretched)

What is the Darley Definition (nontypological)

"Impairment, as a result of brain damage, of the capacity for interpretation and formulation of language symbols; multimodality loss or reduction in efficiency of the ability to decode and encode conventional meaningful linguistic elements (morphemes and larger syntactic units); disproportionate to impairment of other intellective functions; not attributable to dementia, confusion, sensory loss, or motor dysfunction; and manifested in reduced availability of vocabulary, reduced efficiency in application of syntactic rules, reduced auditory attention span, and impaired efficiency in input and output channel selection" (p. 2 in textbook).

Describe It has been found that "tasks that comprise highly organized or integrated parts will not be enhanced by learning of the constituent parts"?

"training on parts of these organized behaviors will diminish learning, particularly when task complexity increases." lack of evidence showing that practice on a part of a task (e.g., subunits of a target phone, such as movement of a single articulator) increases the rate and accuracy of learning of the whole (e.g., accurate production of the target phone)

Describe closed head injuries?

, nonpenetrating brain injuries involved in no open wound in the head, no penetration of a foreign substance into the brain, and a damage brain within the skull. Even when the skull is fractured, the Injury is classified as nonpenetrating if the meninges are still intact. Nonpenetrating injuries may be of acceleration-deceleration type or non acceleration type

Describe feedback?

May be clinician-provided or instrumental Specificity of training

what are the symptoms of the behavioral variant of frontotemporal dementia

(accounts for 70%) notable behavioral changes as initial symptoms in patients with marked right-sided atrophy; notable language changes in those with marked left atrophy behavior disorders, including uninhibited and inappropriate social behaviors, compulsive behaviors, including excessive eating; and delusions, emotional disturbances including depression, apathy, withdrawal, irritability, mood fluctuations, ocassional euphoria, excessive jocularity, and exaggerated self esteem impaired judgment and reasoning and lack of insight

Describe the key components of the Darley Definition

(defined at the Mayo Clinic about 20 years ago) includes the cause, some linguistic elaboration, and some things that are not aphasia: Key distinguishing elements of the Darley model: - Multimodality deficit in the communicative modalities of speaking, writing, listening and reading - Greater impairment of language than "other intellective" or mental functions (attention, perception, memory, reasoning)

How does time of initial test affect prognosis for recovery from stroke?

(depends on when we initially test a pt after stroke; smaller improvement later if the pt is referred; average initial test at 5 mths post-onset) (if very ill when they take it will improve for next time) Additional: history of previous stroke, length of hospital stay, education, motivation, morphological asymmetry

Describe the surgical methods for VP Function?

(e.g., injection/flap) infrequent with neurological patients

What is the practice amount?

(large vs. small) Refers to amount of time spent practicing movements In general, a large number of trials is beneficial for learning nonspeech motor skills.

How does handedness affect prognosis for recovery from stroke?

(laterality of motor functions are commonly assessed by clinical neuropsychologists; LH ppl have more bilateral representation of lang in the brain than RH ppl (applies to half)

How does gender affect prognosis for recovery from stroke?

(males differ from females in function of hemis.; verbal and nonverbal capacities are more evenly distributed in women, whereas men have more familiar asymmetric division of labor)

Describe practice distribution?

(massed vs. distributed) Refers to how a fixed amount of practice is distributed over time Evidence that distributed practice (with more time between sessions) results in greater learning than massed practice (with less time between sessions). Distributed practice facilitates both short-term performance and long-term learning in the nonspeech domain.

What is Cognitive Stimulation?

(person can not name but do they have the words and just can not get to them; so you want to treat underlying processes) Cognitive Stimulation relies on understanding the nature of aphasia. What the clinician does about aphasia depends on what he/she think aphasia is.

How does Age at Onset affect prognosis for recovery from stroke?

(predictor not a factor; changes occur with age but don't indicate possible cause of these changes; older pts may differ accd. to whether they have dementia and other pathologies)

Define Auditory verbal agnosia?

(pure word deafness) impaired understanding of words, but normal hearing and verbal expression, and normal recognition of nonverbal sounds

Describe Movement complexity?

(simple/part vs. complex/whole) Evidence is emerging that targeting complex behaviors promotes learning relative to targeting simple behaviors.

Describe practice variability?

(variable vs. constant) Constant practice refers to practice on only one variant (parameter) of a movement Variable practice targets more than one parameter of a given movement (e.g., practicing a golf swing over varying distances form the hole)

What are the common aspects of most functional communication tests?

* Social communication (talking on the phone, etc.) * Communication of basic needs (for health reasons also) * Daily planning * Assess activities of daily living * Reading/ writing/ number concepts * Movement * Speaking * Functional performance- the use of language without assistance, cues, or artificial conditions

Dementia associated with Parkinson's disease

- -neuropathology of Parkinson's disease includes?~~ -brainstem degeneration -presence of abnormal structures call Lewy bodies -frontal lobe atrophy -reduced inhibitory dopamine due to loss of cells in the substantia nigra -neurofibrillary tangles and plaques of the kind found an Alzheimer's disease

What are some of the causes of dementia

- Alzheimer's disease - Lewy Body Disease - Frontal lobe degeneration - Pick's Disease - Parkinson's Disease - Huntington's Disease - Accumulated small ischemic strokes - Herpes Simplex Viral Encephalitis - Depression - Drug Abuse - Alcohol abuse - Polypharmacy - HIV/AIDs

With respect to reality/ orientation, intervention for dementia involves

- Compensatory strategies comprise the main orientation to cognitive intervention. - "Reality Orientation"- thought to be the 'archetypal' approach to cognitive intervention

With respect to caregiver training, intervention for dementia involves:

- Functional maintenance therapy (FMT) - General recommendations for caregivers: - FOCUSED caregiver communication program

What is Number of Items in cognitive stimulation?

- Language Oriented Treatment (LOT): a variety of stimuli of comparable difficulty. -The specific words don't matter as long as the process is exercised (training sufficient exemplars).

With respect to language and communication, intervention for dementia involves

- Language-oriented therapies begin with word finding ('lexical therapy' through naming from definitions and narratives) - Errorless learning - Treatment may consist of a variety of tasks intended to activate semantic memory, such as: - Group discourse

How is mental slowness assessed?

- Pronounced deficit on the Digit Symbol subtest is an indication of this problem. - Sternberg's (1975) classic short-term memory scanning procedure provides a more precise picture of speed and style. - This task is a short-term recognition task in which response time is measured. - Those with severe CHI were slower than normals but they scanned exhaustively and made matching decisions like the controls.

How does memory affect Sense of Self?

- Severe retrograde amnesia can have devastating affects on a person's sense of self. - "A life without any episodic memory is psychologically barren...Nothing much happens in Gene's life or mind..." see page 190 for full quote

Discuss Short-Term and Working Memory in TBI?

- The Digit Span subtest of the WAIS has exposed a deficiency of short-term buffer capacity in pts with CHI., continuous recognition memory test. A pt can be left with only STM deficit 6 months after injury.

What are the influences of knowledge of an L2 on a person who has had a stroke? What symptoms are likely?

- There may be selective loss of each language - There may be differential recovery of each language. - The extent of language recovery depends upon the person's premorbid mastery - There may be parallel loss of each language - The treatment type is important and its effects may transfer to both languages. - Some patients recover the language spoken in their environment, others the language they are most fluent at and others their native (L1) or first language. - Inhibition and disinhibition of cerebral activity in specific cortical areas are thought to be responsible for the ability to switch between languages.

Clinical management of dementia

- main clinical concerns are to help the patient manage his or her daily routine and to help the family cope with a progressively deteriorating dementia for which there is no cure -in early and intermediate stages communication, memory, and behavior management is targeted

Nonacceleration brain injuries

- these injuries occur when a restrained Head is hit by a moving object. A collapsing car crashing the head of the mechanic work or under is an example. -a great deal of force may crush the head and kill a person in most cases however nonacceleration injuries may fracture the skull, but they produce much less serious consequences for the brain and the behavior of the person

With respect to memory, intervention for dementia involves

-"Spaced retrieval training"- adopted for memory practice -Reduce demands on episodic memory -Support working memory -Provide stimulation and environments to evoke positive memory, emotion and action?

What is Cognitive Stimulation?

-Antecedents (i.e.lang.processes vs. consequences) = events that control a behavior. -Cognitive Stimulation relies on understanding the nature of aphasia. What the clinician does about aphasia depends on what he/she think aphasia is.

Describe Common supplemental tests

-Assess skills not represented in traditional tests, such as functional communication, which targets communication in natural settings. In functional communication assessment, social (pragmatic) use of language and effective communication are more important than phonologic, morphologic, and syntactic accuracy of production. -Provide a more in-depth evaluation of language skills such as naming, auditory comprehension, reading and writing skills. - Assess specific populations such as the mildly or severely impaired.

Describe cognitive strategies?

-Cognitive rehabilitation?~~ trained on specific goals -Cognitive training?~~ improve attention, memory, and executive functioning -Cognitive stimulation group session and in social situations

What are some of the types of dementia

-Dementia of Alzheimer's type. -Frontotemporal dementia FTDs including those caused by Pick's disease-=Vascular Dementias -Reversible Dementias

Causes of TBI

-Falls are the most common cause of TBI and children And elderly are especially vulnerable -28% -automobile accidents, including pedestrian injuries Account for 20% of TBI -about 19% of TBI's are due to being struck or by crashing into objects -assault and interpersonal violence Account for 11% -other causes include alcohol and drug abuse, pre-existing learning disorders, psychiatric disturbances, previous history of TBI

Family members and caregivers need counseling and support when dealing with dementia

-Family member should be educated about dementia, urged to monitor their emotional reactions, including depression, offered counseling and other support services, and offered respite care of patients

The effortful swallow

-Helps increase the posterior motion of the tongue and increase pharyngeal pressure -The patient is asked to squeeze as hard as possible while swallowing

Assessment of swallowing disorder

-Standard procedures such as taking a detailed case history, reviewing medical records, and interviewing the patient, Family, and healthcare workers are part of the total assessment

What is the Success Principle in cognitive stimulation?

-Start with what the patient can do correctly at the 60-80% level. -You do not want to frustrate the patient. Have the patient experience success which gives him/her a sense of accomplishment. -This ensures practicing normal language processing. -If the patient makes 30% or more errors, make the task easier.

Standardized assessment of TBI

-The coma recovery scale revised CRS-R -The Glasglow coma scale -the brief test of head injury -the comprehensive level of consciousness scale -the Galveston orientation and amnesia test -the disability rating scale The Ranchos Los amigos levels of cognitive function

A diagnosis of Dementia Alzheimer's Type (DAT) can be made when the following functions show decline: / or: / What are the (5) general diagnostic criteria for Dementia Alzheimer's type (compared to other Dementias)

-Two or more declining functions from the areas listed OR memory impairment and one other area listed: -Language (ex: misnaming) -Memory (ex: forgetting appointments) -Orientation (ex: getting lost in familiar settings) -Judgment (ex: not wearing a coat in freezing weather) -Occurs in the absence of depression, multiple infarcts, alcoholism, malnutrition, or other conditions that produce similar symptoms.

Give Examples of when behavior modification therapy can be used?

-When a patient perseverates -Who change the subject when the clinician has him/her working on a task that he/she finds difficult to complete. -Patients who exhibit inappropriate behaviors. Behavior modification will help the patient control his/her impulsivity.

What is Feedback upon Error in cognitive stimulation?

-When the patient makes an error re-stimulate instead of verbal reproof or correction because the stimulus was not sufficient. -Steps: "let's try again" & repeat the stimulus. If the patient is still unable to respond correctly, supplement the stimulus with cues. -Incentive and information feedback are not necessary. General encouragement (not for each response) works well with most patients.

Neuropathology of HD includes?

-a loss of neurons in the basal ganglia, significant loss of neurons in the caudate nucleus, putamen, and substantia nigra -atrophy may be found in the prefrontal and parietal lobes as well -reduce levels of inhibitory neurotransmitters especially GABA and acetylcholine

Assessment of dementia

-a thorough case history, clinical examination, neurological assessment, Communication assessment, an assessment of intellectual functions are part of diagnostic activities -definite diagnosis of dementia is possible only after an autopsy

Dementia due to Creutzfeldt-Jakob disease

-although no virus has been microscopically found, it is thought to be caused by an unconventional infectious agent called prion. -features include?~~

In addition, the family members maybe counseled to manage the patient better by teaching them to?

-approach the patient slowly, Touch the patient gently, Established eye contact, and speak clearly and slowly -use gestures, smiling, posture and other cues -talk about simple and concrete events, and talk in simple short sentences -Point out the topic, person, or thing before speaking about it -ask yes or no questions -restate important information -structure the clients room and living environment to establish a routine -always say goodbye are give other departing signals -minimize demands made on the client

Communicative deficits in right hemisphere syndrome

-as noted, only about half of the number of patients with RHD have communication deficits -these deficits are not so much related to syntactic and morphologic aspects of language as to an overall communicative effectiveness in social situations

Piecemeal swallow

-attempts at swallowing abnormally small amounts of the bolus

-in assessing dementia the following skills or domains are typically sampled

-awareness and orientation to surroundings -mood and affect, to assess depression or lack of emotional responses -speech and language -memory and other cognitive functions -abnormal thinking (hallucinations or delusions) -Visio spatial skills

Symptoms of Huntington's disease include

-chorea (irregular, spasmodic, in voluntary movements of the neck head and face) -increasingly uncontrollable tic like movement disorders -Gait disturbances and progressively reduced voluntary movement -slow movement in the advanced stages of disease leading to little or no voluntary movement -behavioral disorders that include excessive complaining, nagging, eccentricity, irritability, emotional outbursts, false sense of superiority, depression or euphoria, schizophrenic like behaviors, delusions and hallucinations, and suicide attempts

How is MS attaxic/spastic?

-control= attaxic Harshness- spastic Excess and equal stress -cerebellar

Speech language and cognitive linguistic problems associated with later stages of Huntington's disease

-deterioration in intellectual functions -impaired Word List generation -naming problems -dysarthria -incontinence, sleep disturbances, sleep reversal, and dysphagia -muteness in the final stages

Affective deficits in right hemisphere syndrome

-difficulty in understanding emotions other people express -difficulty describing emotions expressed on printed faces in story books -recognizing emotions expressed in isolated verbal productions -understanding emotional tone of voice -expressing emotions

Attentional and perceptual deficits in right hemisphere syndrome

-left neglect -denial of illness (anosognosia) -confabulation regarding disability -facial recognition deficits -construction impairment -attentional deficits -disorientation -Visuoperceptual deficits

-increasing the patient's memory for daily routines through written signs that remind the patient -increasing the patient's memory for the names of significant people by asking the patient to name pictures of family members -decreasing the variability in activities and schedules by initially creating a simple structured routine with few activities for the patient -increasing the patient attention to communication partners and topics to promote better comprehension by giving such signals as, "listen carefully now" -improving communicative attention by introducing new topics and warning about topic changes in conversation -teaching the client to ask questions when something said it is not clear to him or her by modeling such questions and statements -withholding attention from irrelevant, inappropriate, or tangential responses to reduce their frequency -teaching narrative skills integrated steps by initially telling a brief and simple story, asking the patient to retell it, and eventually having the client retell more complex stories -integrating such pragmatic skills as topic maintenance and topic initiation into narrative skills by teaching prompts such as "say more" and "give details" -integrating work or school related words, phrases, and narratives into communication selecting client specif work or school-related vocab and expression in treatment sessions using tangible reinforcers when necessary because some patient may not respond to verbal reinforcers teaching self-monitoring skills by including them at all lvels of trainin gteachign compensatory strategies to handle residual effect training family member and ocmmuncation partners in professional settings to recognize, prompt, model, and reinforce appropriate ocmmuncaiton and genral behavior promoting community reentry by preparing the patient for reentry to shcol or work educanig family member, teachers, and supervisors abou the patient= strength and weaknesses, teaching family members, teachers, colleagues, and supervisors to change their style of communcaiton if needed. Swallowing disorders Nature and etiology

-dysphagia involves impaired execution of the oral, pharyngeal, and esophageal stages of swallow -the patient may have problems in chewing the food, preparing it for swallow, initiating the swallow, propelling the bolus through the pharynx, and passing the food through the esophagus.

Daily activities may include teaching the following strategies to the client?

-establishing a simple routine -using various reminders such as alarms, written instructions, staff Reminders, self monitoring devices, etc -writing down a list of things to do every morning -always keeping phone numbers and possessions in a specific place -writing a checklist of things to do before leaving house -always carry a card with the names, addresses, and phone numbers of caregivers -always wearing your bracelet that contains identifying information and names, addresses, and phone numbers of caregivers -writing down important information when memory begins to fail

The Mendelsohn maneuver

-helps elevate the larynx and thus widen the cricopharyngeal opening. -the patient is first educated about the laryngeal elevation, then asked to palpate the laryngeal elevation when swallowing saliva, and finally taught to hold laryngeal elevation during swallowing for progressively longer durations

Additional consequences of TBI

-immediate or subsequent death -loss of consciousness -coma -destruction of brain tissue -diffuse axonal injury -diffuse vascular injury -brainstem injury -focal lesions -infection -penetration of foreign objects -reduce cerebral blood flow -increased blood pressure -swelling of the brain tissue -hydrocephalus -and various types of hematomas (accumulation of blood in an area of the brain) -increased intracranial pressure -ischemic brain damage (Brain damaged due to a lack of blood) -seizures -long-term physical, language, and cognitive deficits -altered consciousness, confusion, disorientation, posttraumatic amnesia, dysphagia, behavioral changes, hallucinations, delusions, confabulation, poor emotional control, social withdrawal, irritability, childishness, unreasonable behaviors

Treatment of swallowing disorders

-in direct treatment, food or liquid is placed in the patient's mouth to shape appropriate swallowing -Direct treatment is designed to reduce problems that are evident in the different stages of swallow

Oral preparatory phase and its disorders

-in this phase food placed in the mouth is first masticated -mastication is chewing salad or semi solid food and mixing it with saliva -well masticated food is prepared for swallowing in the oral preparatory phase by making a bolus (rounded mass of food ready to be swallowed)

Oral motor exercises include?

-increasing the range of tongue movements -increasing buccal tension -increasing the range of lateral movement of the jaw, and of tongue resistance

Indirect treatment of swallowing disorders

-indirect treatment of swallowing disorders does not involve food. Instead various exercises designed to improve muscle strength are prescribed and practiced?~~

Communication disorders associated with TBI

-initial muteness that may last varying periods of time -confused language -dysarthria -naming difficulties -perseveration of verbal responses -reduced word fluency -difficulty in initiating conversation -lack of turn taking in conversation -problems in topic initiation and maintenance -lack of narrative cohesion -impaired prosody -imprecise language -difficulty with abstract language -Reading and writing problems -auditory comprehension deficits -and generally disturbed social interaction

Traumatic brain injury

-injury to the brain sustained by physical trauma or external force -does not include Brain damage due to strokes, tumors, and progressive or transient neuropathologies incidence vary from 150-367 cases per 100,00 persons 1.14 million individuals sustain highest in 0-4 and 15-19 years. 75+ also have a higher providence

Treatment of disorders of the oral preparatory phase of swallow

-involves teaching the patient to better masticate food and generally better handle food in the mouth. The clinician may use procedure such as?~~

Normal and disordered swallow

-it is essential for SLP's to assess and treat swallowing disorders to fully understand the anatomy and physiology of normal swallow as well as swallowing disorders -feeding and swallowing are related but different activities. Feeding a transportation of food from the plate to the mouth; and may be accomplished by self feeding or feeding by others -feeding disorders maybe evident in individuals with motor impairment (paralyzed hands) or severe cognitive impairments -swallowing on the other hand is transportation of food from the mouth to the stomach

Treatment of patients with TBI

-of the variety of treatment approaches advocated for patients w TBI, cognitive rehabilitation and direct communication training are the two most important

Communication treatment

-often involves direct behavioral procedures -systematic reinforcement of attending behaviors, appropriate discourse, topic maintenance, and self correction Will result in their increase and a concomitant decrease in many inappropriate behaviors

What are the features of infectious disease?

-opportunistic brain infections in people infected with the AIDS virus can lead to dementia -HIV infection itself can cause dementia -dementia is of slow onset, but the deterioration is rapid in the final stages -neurologic symptoms include disturbed gait, Tremor, headaches, seizures, ataxia, rigidity, motor weakness, facial nerve paralysis, and incontinence -dementia symptoms include forgetfulness, Poor concentration, slow or impaired thinking, apathy and loss of interest in work, , depression mania, confusion, hallucinations, delusions, and memory loss -language problems are less prominent until mutism that settles in the final stage

Types and consequences of TBI

-penetrating a non-penetrating injuries or two classifications of TBI?~~ they produce different neuroanatomic and behavioral consequences

Symptoms of right hemisphere syndrome

-perceptual and attentional deficits dominate the symptom complex of RHD -affective and communicative deficit accompanying them, but pure linguistic deficits are not typical of RHD

Assessment of communicative deficits associated with TBI

-pure linguistic problems may not be severe or significant patients with TBI. Articulatory or phonological disorders may be noted only if the patient sustained injury to the cerebellum, brainstem, or peripheral nerves. The patient's verbal expression may be grammatically correct

Speech, language, and related problems associated with Parkinson's disease

-reduced speech volume -Voice problems that include mono pitch and mono loudness -Long and frequent pauses in speech -slow fast or festinating speech rate -dysarthric speech -serious memory problems, problems in abstract reasoning and problem solving -impaired visuospatial perception -impaired word list generation - severe naming and language comprehension problems in later stages of the disease -apathy, confusion, hallucination, and delirium -micrographia

Infectious dementia

-several infectious diseases lead to dementia and dementia due to HIV or Creutzfeldt-Jakob disease is common -dementia due to HIV infection is subcortical and is known as aids dementia complex or human immunodeficiency virus encephalopathy and includes the

Communication treatment goals

-should be functional, with the initial focus on effectiveness of communication not grammatical correctness. Family members should be involved in treatment. Several other treatment goals include?~~

Neurologic symptoms of Parkinson's disease (PD) included

-slow voluntary movements (bradykinesia) -tremors in resting muscles, starting in the hand or the foot, tremors exacerbate during stress -muscle rigidity increased tone and resistance to movement -mask like face -reduced eye blinking, festinating gate, disturbed posture, frequent falls, and freezing during movement -swallowing disorders -sleep disturbances cogwheel rigidity, or tension in a muscle that gives way in little jerks when the muscle is passively stretched.

Dementia associated with Huntington's disease

-subcortical -typical age of onset is 35 to 40 years -mutation on the short arm of chromosome 4 has been documented -a malformed protein called Huntington kills the brain cells that control movement -40-70 persons in a million typical onset 35-40years

specific swallow maneuvers

-techniques designed to compensate for specific problems associated with dysphagia- they may helped gain some degree of control over certain in voluntary aspects of swallow

Standardized tests of dementia

-the Arizona battery for communication disorders of dementia (ABCD) is specifically designed to assess dementia associated with Alzheimer's disease -it screens speech discrimination, Visual perception and literacy, etc -the blessed dementia scale helps evaluate changes in performance in 8 every day activities -the global deterioration scale -test of language comprehension (Peabody picture vocabulary test) are useful in assessing receptive language skills -intellectual skills may be assessed by administrating selected tests of memory and general intelligence -client specific tasks as picture description to help asses various intellectual and language skills, including temporal sequencing, logical connections, grammaticality of senteces, topic maintenance, and so forth Describe the Arizona Battery for Communication Disorders of Dementia?~~ Mild to mod impairments in speech discrim, visual perception and litearacy, visual field, visual agnosia, mental status, linguistic expression, linguistic comprehension, and visual-spatial construction

What is Managed care in programmed stimulation?

1. terminal response needs to be functional: i.e., request an item at a grocery store. 2. small steps may not be necessary for patients who show bursts of improvement. Bigger steps are ok.

Assessment of right hemisphere syndrome

-the mini inventory of right brain injury- Second edition (MIRBI-2) -the right hemisphere language battery Second edition (RHLB-2) -the rehabilitation Institute of Chicago procedure manual- clinical management of right hemisphere dysfunction - the Test of visual neglect -the bells test -the behavioral inattention test (BIT)

Esophageal phase and its disorders

-the swallowing phase is not under voluntary control -it begins when the food arrives at the orifice of the esophagus -food is propelled through the esophagus by peristaltic action and gravity into the stomach -bolus entry into the esophagus results in restorative breathing and a depressed larynx and soft palate

Oral phase and its disorders

-this phase begins with a anterior to posterior tongue action that moves the bolus posteriorly -the phase end as the bolus passes through the anterior faucial arches when the swallowing reflex is initiated

Pharyngeal phase and its disorders

-this phase consists of reflex actions of the swallow -reflexes are triggered by the contact of food makes with the anterior faucial pillars. -the pharyngeal phase involves velopharyngeal closure, laryngeal closure by an elevated larynx to seal the airway, reflexive relaxation of the cricopharyngeal muscle for the bolus to enter, and reflexive contractions of the pharyngeal contractors to move the bolus Down and eventually into the esophagus

Stimulating swallow exercises include?

-touching the base of the anterior faucial arch with a laryngral mirror dipped in ice water for about 10 seconds (thermal stimulation) -asking the patient to swallow after the stimulation without food -practicing liquid swallow after simulation -progressively increasing the consistency of food introduced after simulation

the right hemisphere controls

-understanding holistic gestalt stimuli, Visual perception, geometric and spatial information -facial recognition, drawing, and copying -arousal, attention, an orientation -emotional experience and expression -perception of musical harmony -certain prosodic features of communication, understanding ambiguous meanings, expressing an understanding the emotional tone of speech, understanding discourse, and pragmatic language skills

Other forms of dementia

-vascular dementia -dementia associated with multiple cerebrovascular accidents -dementia associated with TBI

How does fasciculation help you make a differential diagnosis? Wont see fasciculation with UMN damage

...

What are the articulation characteristics in Huntington's? amount of dysarthria depends on whether oral mechanism is affected variable articulatory precision (articulatory breakdown - DAB)

...

What are the prosodic characteristics in Huntington's? overall impression of prosodic deviations

...

What are the respiration characteristics in Huntington's? excessive loudness

...

What do assess for the Face, Jaw, Tongue at rest symmetry extraneous movements during sustained postures during movement

...

What measures are obtained by the AIDS?_ Single word intelligibility and sentence intelligibility

...

What is asymbolia?

1) A loss of the ability to comprehend by touch the form and nature of an object. 2) A form of aphasia in which the significance of signs cannot be comprehended. Also called asemasia. language and pantomime deficits are part of a broad disorder called asymbolia Iconicity: the physical similarity between a gesture and its referent. (Iconic gestures are replicas of their referent i.e. a clenched fist vs. a salute**look in notes). Intentionality: aphasics retain unintentional or subpropositional emotional expression or reaction. Investigators tried to separate cognitive and motor factors in gesture production. It was found that miming the use of objects was correlated with severity of aphasia and that apraxia contributed little to pantomime performance.

2 muscles of the inferior constrictor

1. thyropharyngeus 2. cricopharyngeus

motor innervation for swallowing (4 nerves)

1. trigeminal 2. glossopharyngeal 3. vagus 4. hypoglossal

Describe the implications of Skelton and Hagopian's study?

1. Because the children could successfully practice their targets in tasks that varied across a range of response lengths after limited speech sound establishment in a single word, practice variability may be increased after very limited speech sound establishment. 2. Because this study incorporated a range of response lengths that went from syllables to the participants' longest comprehensible response length (three-word phrases), this may suggest that a child's current response abilities may be used to create a range of response lengths for practice tasks. 3. These results suggest that clinicians have a few options for ordering practice tasks: blocked (teaching targets in the same practiced task until it is taught to a criterion), random (shifting the practice task after each trial as was done in the present study), or a combination of both (having the order of practice tasks randomized and each task practiced a specified number of trials before moving to the next task).

How does retrograde amnesia affect recovery?

1. During recovery, the amnesic gap shrinks toward the time of injury. 2. A mild gap comprises 30 minutes prior to injury and is usually long lasting. 3. Compared to anterograde amnesia, retrograde is more prominent and resilient after the pt regains consciousness. (lasts longer) 4. Cognitive rehabilitation is affected by duration of post-traumatic amnesia (temporary period of diminished awareness of the... . 5. PTA is said to end when a pt "remembers today what happened yesterday and does not begin each day with a blank mind."

Are the Results fairly consistent of testing anterograde amnesia?

1. Found impairment in explicit testing (present one word of a pair and see if pair is remembered) but not implicit testing (see if subject completes stems from a list more accuractly or faster than stems not on the list - because it's hard to know what these test allude to) 2. Implicit recall also indicates that new information can be acquired and retained for a while 3. Thus, the impairment lies in effortful retrieval processes 4. Yet there is also a stimulus encoding problem mainly in the first year postinjury and the problem with distractibility. Both of which can make it difficult to acquire new information

How is the thermal tactile stimulation performed?

1. Hold the mirror like a pencil so you can easily rotate it in your hand. 2. Dip it in ice. 3. Rub it up and down five times on one of the anterior faucial arches. 4. Dip the mirror back into the ice quickly. 5. Rotate it so the flat head of the mirror is facing the other direction. 6. Rub it on the other faucial arch. 7. Swallow.

What are the language comprehension abilities of RHD pts?

1. Occasional difficulty arranging words into grammatical sentence, but grammaticality judgment is intact 2. Comprehension of thematic roles in passive sentences may be a problem (e.g., The girl was kissed by the nurse: may think the girl kissed the nurse rather than the nurse kissed the girl) 3. Do not usually have STM deficit 4. Mild deficit when presented with 4 semantically similar picture options

What is a third tongue base retraction exercise?

1. Open your mouth wide. 2. Start to yawn. You will feel all the muscles open wide in your throat and mouth.

The general characteristics of phonological output processes in conduction aphasia (5-6 statements)

1. Patients with conduction aphasia (fluent aphasia) produce sound-related word errors, either formal paraphasias or and phonemic paraphasias. Phonemic paraphasias are not real words but are related by sound (e.g., slazer for razor) and formal paraphasias are real words (e.g., laser for razor). Most sound-related errors are nonwords, but a few patients may produce a high rate of formal paraphasias. 2. Conduction aphasia does not involve the all-or-none retrieval found in anomic aphasia. 3. Phonemic errors in conduction aphasia are diagnosed as a disorder at a pre-articulatory phomemic level in the language system. 4. Motor function or articulation in conduction aphasia is normal. 5. Errors do not increase as a function of motor complexity. 6. In conduction aphasia, there may be a common disorder underlying the impairment of a phonological input buffer and a phonological output buffer.

What are the general patterns of comprehension abilities (and problems) of persons with agrammatism. You should be able to make 5-6 general statements about this

1. People with Broca's aphasia can use semantic or pragmatic constraints to comprehend thematic roles but are impaired when they must rely on the syntactic feature of word order. 2. They had particular difficulty with passive sentences and errors were mostly order errors (even with reversible active sentences). 3. People with Broca's aphasia have difficulty with word order when it is the main cue to thematic roles. 4. Considered an 'asyntactic comprehension' disorder 5. Patients do well on word comprehension and grammaticality judgment tasks.

How is the bolus control exercise performed?

1. Place gauze between clients tongue and palate 2. Clinician holds opposite end of gauze 3. Ask client to move gauze side to side and front to back

What is a variation to vocal cord adduction?

1. Place one or both hands under your chair, and pull as if you were trying to lift your chair up with you in it. 2. Hold your breath tightly. 3. Let go of your breath (still pulling) and say "ahh."- hold for 5-10 seconds

How do you complete resistance lip exercises?

1. Place tongue depressor horizontally between upper and lower lips. 2.Instruct client to close lips tightly and hold tongue depressor while the clinician tries to remove it.

What is the procedure of the Valsalva maneuver?

1. Take a breath. 2. Bear down and hold your breath. You should not hold your breath with your lips, but in your throat, like you do if you are trying to lift something very heavy. 3. Hold for _______ seconds and then let go.

What is the Theoretical Targets of Treatment for cognitive stimulation?

1. Treat underlying processes of aphasia (do not do stimuli and response therapy). 2. Treating a general process may affect several specific communicative abilities that depend on that process a. For example, when targeting the process of word finding, you are also improving sentence production ability 3. General (mental) processing systems: a. Comprehension b. Production c. Word-finding

Describe feedback upon Error in cognitive stimulation?

1. When the patient makes an error re-stimulate instead of verbal reproof or correction because the stimulus was not sufficient. 2. Steps: "let's try again" & repeat the stimulus. If the patient is still unable to respond correctly, supplement the stimulus with cues 3. Incentive and information feedback are not necessary. General encouragement (not for each response) works well with most patients.

Disorders of the oral phase include?

1. anterior, instead of posterior, tongue movement and generally weak tongue movement 2. reduced range of tongue movement and elevation 3. tongue thrust 4. reduced labial, buccal, and tongue tension And strength 5. food residue in various places (anterior and lateral sulcus and the floor of the mouth) suggesting incomplete swallow -premature swallow of solid and liquid food and aspiration before swallow, caused by apraxia of swallow

Treatment of disorders of the esophageal phase of swallow

1. avoid certain foods (coffee, alcohol, Citrus juices, fatty foods) 2. eat small portions of food and eat 2-3 hours before bedtime 3. elevate the head of the bed 4. lose weight if overweight 5. stop smoking 6. staying upright position 30 minutes after eating

The clinician should also follow these procedures?

1. before beginning of formal assessment of swallowing, assess the clients ethnocultural background, food habits, preferred and avoided food or liquids, and any dietary restrictions due to health problems or cultural background 2. screen speech, Voice, language, and writing skills using the clinical interview. Errors of articulation, Voice quality, Pitch, and loudness characteristics, and the presence of hypo or hypernasality maybe noted 3. screen concrete and abstract language comprehension by giving a few simple verbal commands, by asking the patient to give the meaning of commons proverbs and phrases. Differences or deviations in the use of language, if any, it may be noted to better assist the treatment process 4. conduct a laryngeal examination with indirect laryngoscopy or endoscopic examination to inspect the base of the tongue, valleculae, epiglottis, pyriform sinuses, vocal folds, ventricular folds, and their functioning 5. administer test swallows, taking into consideration the patients medical condition, and the type of swallowing disorders. Collect the necessary materials (a laryngeal mirror, a tongue blade, a cup, spoon, straw, syringe, and various foods of different consistencies) 6. correctly position the patient for test swallows. For example, in the case of tongue weakness and bolus manipulation problems, the patient should tilt the head downward as food is placed in the mouth and tilt the head backward when swallow is initiated. In the case of a hemilaryngectomy, delayed trigger of swallowing relax, and inadequate laryngeal closure, the patient should tilt the head downward to hold food in the valleculae until the reflex is triggered 7. appropriately placed the food in the mouth. For example, place food in the more normal side of the mouth or use a straw or syringe to Place liquids posteriorly 8. use different kinds of food and evaluating test swallows. For example, use liquid foods or food of thin consistency when the patient has a limited oral control and foods of Thicker consistency when the patient's swallowing reflex is delayed 9. give appropriate instructions for head position and swallowing 10. Manually examine the swallowing movements by placing the index finger just below the chin, the middle finger on the hyoid, and the 3rd and 4th fingers at the top and bottom of the thyroid to take note of the submandibular, hyoid, and laryngeal movement during swallowing or aspiration 11. Conduct a videofluorographic assessment (MBS) of oropharyngeal swallow involving lateral and anterior posterior (A-P) plane examinations 12. Conducte a FEES using liquid and food consitistencies 13. Conduct a manometric assessment with the help of an esophageal manometer, which measures pressure in the upper and lower esophagus 14 Conduct an electromyographic assessment by attaching electrodes on structures of interest (oral, laryngeal, or pharyngeal muscles). Conduct an endoscopic assessment to examine the movement of the bolus until it triggers the pharyngeal swallow and any food residue after swallow 15. Conduct an ultrasound examination to measure tongue movement and hyoid movement

CN VII muscles (11)

1. buccinator 2. orbicularis oris 3. digastric (posterior belly)

Disorders of the pharyngeal phase include?

1. difficulties in propelling the bolus through the pharynx and into pharyngeal-esophageal sphincter (PE) segment 2. delayed or absent swallowing reflex 3. nasal and airway penetration of food 4. food coating on the pharyngeal walls 5. food residue in the valleculae (Space between the base of the tongue and the epiglottis) on top of the airway, in the pyriform sinuses, and throughout the pharynx 6. Delayed pharyngeal transit 7. reduced pharyngeal peristalsis 8. pharyngeal paralysis 9. inadequate closure of the airway; aspiration before and after swallow 10. Reduced movement of the base of the tongue; 11. reduced laryngeal movement 12. cricopharyngeal dysfunctions

CN XI muscles (5)

1. levator veli palatini 2. palatopharyngeus 3. palatoglossus

CN V muscles (7)

1. masseter 2. temporalis 3. medial pterygoid 4. lateral pterygoid 5. mylohyoid 6. tensor veli palatini 7. digastric (anterior belly)

2 types of esophagus innervation from the vagus nerve

1. meissner's plexus 2. auerbach's plexus

CN XII muscles (8)

1. styloglossus 2. genioglossus 3. hyoglossus 4. geniohyoid 5. inferior longitudinal 6. superior longitudinal 7. verticalis 8. transversus

CN IX muscles (2)

1. stylopharyngeus 2. palatoglossus

Treatment of disorders of the pharyngeal phase of swallow

1. teaching the patient to tilt the head forward while swallowing, to compensate for delayed or absent swallowing reflex 2. teaching the patient to switch between liquid and semisolid swallows so that the liquid swallows help clear the pharynx to compensate for reduced peristalsis 3. teaching the patient to tilt the head towards the stronger side if the patient has a unilateral paralysis inland won't function and in the pharynx 4. teach the patient to tilt the had forward while swallowing or placing pressure on the thyroid cartilage on the damage side to improve laryngeal closure

what are the stats on FTD?

10% of cases, third most common form in patients younger than 65, it is the second most common

What age does stage III correspond to?

12-24 months

How many sections are in the frenchay?

7

What is the minimum respiratory support?

<3 cm-h20 is about the minimum to generate vocal fold vibration.

What were the findings for the speaking rate conditions?

A = speak at "normal" rate B = use rate where intelligibility is 90% C = slow rate additional 25% compared to B D = slow rate as much as possible Get to 90% then speed it up again. Speaking louder may be an indirect way at decreasing rate

What is apraxia a disorder of?

A disorder of motor planning which may be acquired or developmental.

What is the development of speech from other behaviors?

A dynamic systems model of speech acquisition also posits that early rhythmic behaviors (e.g., chewing and sucking) are modified to form diverse behaviors. However, the coordination between speech structures (e.g., lip and jaw) continues to develop over a number of years.

Define apraxia according to McNeil, Pratt, and Fosset?

A phonetic-motoric (motor planning and programming) disorder of speech production caused by inefficiencies in the translation of a well-formed phonologic frame to previously learned kinematic parameters for carrying out the intended movement (McNeil, Pratt, and Fossett, 2004)

Describe AAC?

AAC aids and strategies may be successful in supplementing the child's natural speech and provide greater opportunities for facilitating language development, communicative competence, and academic achievement. Using AAC aids and strategies, children may have greater opportunities to initiate and maintain interactions as well as to repair communication breakdowns across various communication situations with both familiar and unfamiliar communication partners

What are the mixed dysarthrias?

ALS

Describe alternating motion rates?

AMRs to determine speed and regularity of reciprocal movements of jaw, lips and tongue (e.g.,

What are the issues in development of abnormal oral-motor skills?

Abnormal postures, tone and movement and abnormal sensory integration

How do you Document Functional Outcome?

Administer a probe or getting family reports of the patient doing something new. "Significant functional change" must be documented to medicare. Indicate what the pt could do then and can do now. Social validation (novel social dyad). Quality of life...Treatment should reflect a meaningful change in the patient's life

What were the subjects of Yorkston & Beukelman?

Ages 23-55 Etiologies = anoxia or head injury Inclusion criteria Initial intelligibility scores <30% Speaking rate >100 wpm for oral reading

What is targeted in AOS?

Agility, not strength

Describe treatments aimed to increase strength or compensate for weakness?

Aimed at respiratory, phonatory, and articulatory components of speech If there is some residual LMN innervation to specific muscles, then restorative exercises are appropriate. However, if LMN innervation to specific muscles is known to be lost, exercises designed to strengthen those muscles cannot work. The goal of treatment becomes compensatory as opposed to restorative.

What are the disorders described by hypokineasia?

Akinesia, bradykinesia, rigidity, postural instability

What are the Possible correlations between motor skill development for feeding and for speech?

Although causality cannot be established, there is probably some common system to support the initial stages of feeding and early speech development. Patterns of sucking, swallowing, biting and chewing may provide basic movement patterns that are modified for speech.

What is the rationale of pacing strategies?

Although neurologically-normal speakers tend to get more variable at slower rates, rate control strategies are commonly used in dysarthria treatment

Describe the surgical intentions and hyperkinetic dysarthria?

Although these may result in some improvements in speech, that is not their primary purpose

Be able to provide an example of a Compensatory Behavior that may be used in tx for severe aphasia?

An aphasic individual should try to maximize the use of his or her residual communicative resources By using more modalities to communicate you increase communication and connections in the brain, which will probably have a positive effect on speech as well. a. Low tech strategies: drawing and using communication books b. High tech strategies: include using computers and other electronic devices

In evaluating right hemisphere disorders how useful are aphasia batteries??

Aphasia batteries are not that useful in evaluating RHD (i.e., aphasia batteries do not highlight the areas in which the patient with RHD is deficit)

What are the two types of visual agnosias?

Apperceptive and Associative

What are the problems of Attention that may be present after TBI?

Arousal, awareness, selective, sustained, and divided

How else might the errors present?

Articulatory errors appear to be at times perseverative, with the recurrence of phones recently articulated, and at times anticipatory, with the premature introduction of a phoneme that appears in a subsequent word. The existence of fluent speech surrounded by stretches of poorly articulated speech identifies this problem as distinct from any other.

What is important about comprehensibility?

As the richness of the information from the acoustic signal is degraded (as in severe dysarthria), the signal-independent information becomes more critical for maintenance of comprehensibility. Contextual information may decrease the burden of communication that is placed on the listener, making communication exchanges easier

How is the effortful swallow performed?

As you swallow, Squeeze hard with all your muscles.

What is the relationship between planningand program and the motor system?

At both the planning and programming levels, the assumption is that phonologically-intact information is input to prelearned routines of the sensorimotor system for carrying out precisely timed and coordinated movements within and between articulators and the muscles used for speech. Thus, a direct relationship exists between the linguistic units and the implementation by the motor system.

What is cervical auscultation used for?

Aurally monitor the pharyngeal stage of the swallow and breathing Stethoscope microphone

What can be used to increase airflow?

Biofeedback to increase airflow---- air on a tissue, mirror, hand, or a device to measure airflow. Many apply lsvt to adduction.

Describe behavioral management for hyperkinetic dysarthria?

Bite block may help those with mandibular dystonias Sensory "tricks" or postural adjustments for focal dystonias of the face or jaw Slowing my help those with action myoclunus ? effectiveness for spasmodic dysphonia

What are the predominantly bulbar signs in ALS?

Breathiness and stridor

Name the nonfluent aphasias?

Broca's aphasia, Transcortical motor aphasia (TMA), mixed Transcortical Aphasia (MTA), Global aphasia

What are some cortical conditions and how do they relate to spastic dysarthria?

Broca's will not be dysarthria because of the bilateral contribution Two cortical lesions- bilateral will be paralyses Pariesis- bilateral weakness. See with degenerative or multiple strokes

How does Conduction Aphasia affect prognosis for recovery from stroke?

Btwn Broca's and anomic aphasias in severity of lang impairment

Did the rate cause the intelligibility?

But have to know what is causing them to be unintelligible. He wasn't unintelligible because of rate but because of TBI. But that's not always a compensatory strategy.

Describe the Communicative Effectiveness Index?

CETI Helps assess four domains of functional communciation skills: social needs, life skills, basic needs, and health threat. Such as yes-no answers, physical pain or discomfort and starting a conversation are rated.

What is important about communication?

Changes in communication will impact their swallowing: may refuse to eat something but they cannot communicate to us that they do not want it.

What is derivational paralexia?

Changes structure and grammatic category- strange for stranger

What is the effect of exercises?

Changing and improving muscle structure. Exercises have been found to efficacious for swallowing.

What is progressive supranuclear palsy characterized by?

Characterized by cell loss in numerous areas of the brain, including structures and pathways of the motor system (e.g., GP, SN, thalamus, subthalamic nucleus, brainstem nuclei and cerebellum [cranial nerves and cortex (except frontal lobe) are usually spared]

Describe consistent and variable practice?

Consistent practice includes successive productions of verbal responses without intervening stimuli Variable practice incorporates more elements into responses (e.g., minimal contrasts)

What does clinical detection of left neglect includes (examples of tasks...)?

Crossing out test (marking lines through circles scattered about a page), Line cancellation test (marking lines through circles scattered about a page; sheet of paper with lines, tell pt to cross out lines, they will only cross out the lines on the right side), Line bisection test(ask them to write a line in the middle; they will do it in the middle of the right side; pts asked to mark the center of a horizontal line), Cued-line bisection (letters at the end of lines to draw attn.., anchors, biased; put letters to draw attn.. leftward) Studies have shown Double dissociation between left neglect and nosoagnosia for paralysis (they do nto always co-occur) Keep left neglect in mind when asking the patient to do reading tasks, visual scanning tasks, etc... SL: uses lift side of signing space- despite neglect of l-hemi space in non-languae tasks_ brush hair, draw etc. because language is a left hemisphere function Wheelchair obstacle course: RHD pts with and without neglect tended to sideswipe more things n their left

superior longitudinal function

elevates, retracts tip of tongue

only 5 ccs at a time. Has to go down to the neutral position and be picked back up. Reusable.

Describe glossectomy spoon?

Transient effect on swallowing 3-4 weeks for re-evaluation

Describe postural techniques?

foam and curved; reduced grasp, don't have to gurn fork to the mouth. Can get weighted utensils. Weighted is good for those with tremors or with essential tremor. Hinged spoons that can move so that when it is tremoring, it wont spill.

Describe rocker knives?

Reduced tongue coordination Delayed initiation of the swallow Reduced laryngeal closure (reduced laryngeal elevation and excursion)

Describe spoon thick?

What does extrapyramidal lesions do?

Damage to the BG control circuit either reduces movement (hypokinetic) or results in a failure to inhibit involuntary movements (hyperkinetic).

How does low tone and poor proximal stability interfere?

Deficits in trunk and head control may contribute to compensatory movement patterns of the lips, tongue and jaw.

What is the data indicating?

Demonstrate at acoustic, aerodynamic, kinematic and physiologic measures May also produce some benefit with other dysarthria types

What does vital stim feel like?

Depending on level of stimuation it feels like pin and needles and then with deeper stimulation, it becomes like a massage. They are falling off.

What is important about oral stability?

Depends on development of neck and shoulder girdle stability and control Facilitates efficient movement for feeding and speech

more stability

Describe Provail cup?

can be rocked with built up handles. Can get utensils with a cuff.

Describe built up plates?

built up utensils, rocker knives, built up plates, cup with two handles, provail cup, glossectomy spoon, mirrors, placemat

Describe built up utensils?

Stretching of the cricopharyngeal region

Describe dilation of scar tissue?

Always at risk for reflux and vomiting. Used for patients with severe cp dysfunction, tried dilatation, botox.

Describe the surgeries to control aspiration?

Don't immediately want to go to food consistence, increases burden of care, quality of life,

Describe thin liquids?

What factors do you consider for the whole patient?

Diagnosis Prognosis Reaction to compensatory strategies Severity of dysphagia Communication Status (expression, comprehension) Visual status Motor status Respiratory function Caregiver support Patient motivation

What are the general perspectives for management of AOS and Dysarthria?

Difference in nature of activities aimed at restoring lost function dysarthria therapy is aimed at improving physiologic support AOS therapy focuses on re-establishing the programs or ability to program speech movements

Who is the supraglottic swallow good for?

Difficult with oral control

Define Visuospatial Orientatio?

Difficulty in finding one's way around; (there are different types of disorientation...) f. Topographic Disorientation: fails to orient themselves to the immediate environment; difficulty reading maps, learning new routes, remembering familiar routes g. Geographic Disorientation: fails to orient to general location (like...NJ); relates to immediate surroundings but fails to conceive of general location h. Reduplicative paramnesia: false memory of a situation or place that is similar to an existing one (going to a target store when you've never been to one before and there is a section that reminds you of K-Mart you think you've been there before. So you would expect to find objects where they would be in K-Mart - you insist that you've been there before even if they haven't.)

Who is the Valsalva not effective for?

Do not perform with tracheostomy tub or with uncontrolled high BP.

How does the frenchay help with weaknesses?

Do strengthening in speech, doesn't't believe in the oral motor exercises. Frenchay gives you where to start, have weakness, wont work on strengthening immediately.

Describe pharmacologic treatments for hypokinetic dysarthria?

Dopamine-agonist medications (e.g., Sinemet) may result in general improvements in speech, but often these improvements are not as great as they are for other types of movements Effects of parkinsonian medications can fluctuate as a function of the drug cycle

Describe the Moro reflex (startle reflex)?

Elicited when infant's head is dropped back or with a loud noise Infant will lift and open arms, then suddenly bring them together

How is the awareness of bolus swallow initiation performed?

Downward pressure of spoon against the tongue Can be done with dry cold metal spoon or with bolus

What are some non-verbal modalities?

Drawing, conversational gesturing, communication boards

What is important about intensive drill?

Drill becomes systematic when responses are based on careful selection and ordering of stimuli that ensure a high level of success at each step of the treatment program

What are some of the variables that may affect prognosis for recovery from Traumatic Brain Injury?

Duration of optimal recovery Severity of injury Type of injury (diffuse vs.focal) Secondary injuries Level of consciousness Depth/duration of coma Papillary reactivity at admission Age of patient Drug abuse or alcoholism PTA duration.

What are the basic tenets of the DAB approach?

Dysarthrias can be recognized by their distinctive characteristics. They can be distinguished from normal and non-neurologic speech disorders. Similarities logically reflect lesion loci and, presumably, common underlying pathophysiology. The implications of these assumptions is that recognizing distinctions among the dysarthrias

What kind of questions do we ask when using the frenchay?

E.G do you have a cough, or difficulty clearing your throat etc- no difficulty= a; occasional difficulty b, ½ per day, extra care- c; chokes at times other than meal times -d; no cough reflex at all and on a feeding tube lip spread- smile Most misleading is the lower motor neuron---- can be variable.

What are the treatments for hyperkinetic dysarthria?

Effective management approaches are primarily surgical and pharmacologic. Pallidotomy, thalamotomy and DBS are used to manage dyskinesia and dystonia Botox for spasmodic dysphonia Medication is only occasionally helpful

What have studies found?

Efficacy studies have shown that choices of technology are more dependent on factors as the user's desire to be perceived as able or mentally competent rather than on function alone.

What are the characteristics of articulatory errors associated with AOS?

Effortful groping to find the correct articulatory postures and sequences of them Uncertainty as to where articulators are or of how to move them in a given direction or to a given position. Some movements appear to be random, whereas others are clearly mistaken postures. Facial grimacing is common, accompanied by silent and phonated movements of the articulators. Articulatory difficulty involves consonants more often than vowels. Inconsistent and highly variable articulation errors that are not referable to specific muscle dysfunction.

How are range of motion tongue exercises performed?

Elevate tongue tip to alveolar ridge- hold for 1 second Elevate back of tongue to soft palate-hold for 1 second Move tongue side to side within oral cavity- hold for 1 second in right and left lateral sulcus Protrude tongue outward and hold midline- hold for 1 second Retract tongue- hold for 1 second

Describe the Sucking and rooting response?

Elicited by stroking infant's cheek Will turn toward stimulus and begin sucking

What is the relationship between feeding and speech development?

Even though they are very different acts= feeding probably forms a foundation for speaking. Although the relationship between automatic nonspeech movements and speech production skills has never been established, a relationship may exist at the prespeech levels of feeding and early sound play in the neurologically-impaired infant or child. Morris believes that for children with cerebral palsy and other congenital neurological disorders, it is possible to effect change in the development of articulatory and phonatory skills through intervention at a nonvolitional, nonspeech level of sensorimotor programming.

Describe the practice schedule in general?

Evidence that random practice enhances motor learning as shown by retention and transfer tests in the nonspeech domain. Regarding speech, there is preliminary support for the use of random rather than blocked practice for both intact and impaired speech motor systems.

What are the other approaches/techniques?

Exploit phonetic context Overarticulation Contrastive drills Work on movements in syllables rather than fixed articulatory positions Use meaningful stimuli Determine when compensatory movements are necessary and, therefore, acceptable Acceptable approximations may be the most you can expect

How does fluent versus nonfluent affect prognosis for recovery from stroke?

Expressive or nonfluent aphasia have been found to make more progress than receptive or fluent aphasias • Nonfluent aphasias had less progress in verbal expression and in reading and writing than fluent aphasias

what does neuromuscular electrical stimulation do?

Facilitates contraction of swallowing muscles May impact sensory awareness electrodes attached to skin small electrical impulses

Who will only be affected by respiratory function?

Few types that have respiratory as the only problem==== respiratory control or because of phonatory control ALS affects respiratory muscle

What dysarthria results from LMN lesion?

Flaccid

Describe behavioral management for AOS?

Focuses on Improving ability to program speech Articulation and prosody Treatment directed at speech more than nonspeech tasks

What is targeted with agility?

For a child with AOS, don't work on static postures or even individual sounds. Don't do exercises that promote movements not used in speech (e.g., tongue wagging or protrusion).

How is test retake effects limited?

For every sentence length, there are 100 sentences. 5- 15 word sentences. Pick 1 sentence from each form.

Describe This finding is consistent with 'dynamic systems' models in that "the relevant sensory-motor correspondences are prerequisite for motor learning."?

For example, knowing the auditory-perceptual consequences of articulatory movement is necessary for typical speech development. 'Fractionating' a behavior into its component parts will probably not provide the necessary sensory-motor information. 'Simplification' of a task (which is not the same as 'fractionating'), on the other hand, may help to promote generalization.

Describe behavioral management for hypokinetic dysarthria?

For rate, use of pacing boards and DAF For volume, use of amplifiers/feedback or change in posture Some evidence of benefit of exercise programs

Describe specificity of training?

For the patient who can produce speech at the word level Inappropriate to focus on nonspeech, sound-level or nonsense syllable tasks Words and phrases are more motivating and meaningful

Describe the language and cognition changes in Stage 1 Early Mild stage of Dementia

Forgetful Disoriented Careless Can follow established routines Usually comprehends Vague words in talk Word fluency impaired Good repetition Some word finding difficulty

Describe Tasks intended to activate semantic memory

Free and prompted descriptions of Norman Rockwell paintings Associations to evocative words Proverb completion and interpretation

What do we use to assess function?

Frenchay Dysarthria Assessment Second Edition-

What is Functional Stimulation?

Functional stimulation or functional repair is improving impaired language processes by using functional treatment exercises.

Describe lateralized sign identification with object recognition?

His recognition of objects was strongly affected by neglect, but recognition of signs was not affected (re: attention and reading) This dissociation is another demonstration that the visuospatial modality, per se, is not as significant functionally as the system underlying use of the modality (i.e., the intact left hemisphere's linguistic system appears to have overriden the visual attention deficit.)

How do we test vital stim?

Hold for one minute- put them on and see the reaction of the individual to it. Once to the desired level, remain contraction for a minute and then it drops= 45/60 minutes placed. Following vital stim protocol- every two wakes.

Patients have to remember to do these We can use a visual cue on the table. Have them at the end fo the table so that they look at the wall or the table.

How do we encourage them to use them?

Resource® ThickenUp® Thick & Easy® Thick-It®

How much thicken to usual liquid in terms of hydration?

Is AOS a phonological disorder?

However, AOS is not necessarily considered to be a phonological disorder, although disturbances in speech motor control may co-occur with a phonological disorder

what is there empirical evidence for?

However, empirical evidence regarding practiced amount is available with respect to speech motor learning.

What is a quick hyperkinesia?

Huntington's Chorea

What are the resonance characteristics in ALS?

Hypernasality

What are the resonance symptoms of flaccid dysarthria?

Hypernasality nasal emission

What are the two general groups of extrapyramidal dysarthria?

Hypo and hyperkinetic.

Give an example of a task you ask your patient to perform to document functional outcome?

If one of the goals in treatment were to improve naming (what is this? a pen.) and the treatment procedure was to complete sentences (We use a ____ to write.) we could probe for the vocabulary not used in treatment to see if what we worked one is generalizable. (probe for pencil)

What is the purpose of expiratory muscle strength training?

Increased duration and amplitude of submental muscles Improved airway protection with Parkinson's Laryngeal elevation and effort. "the breather" and can you adjust the level of expiration. Blowing in a balloon.

What is the limitation for surface EMG?

In the swallow signals lab. Limitation is not measuring a specific effort but measuring the whole area

What does the Mendelsohn maneuver do?

Increase elevation and excursion if you can do it.

What is the goal of resistance lip exercises?

Increase labial closure

Describe an exercise to increase subglottal pressure?

Increase subglottal pressure- blow bubbles, positional, conscious to breath, and have scripts marked to remind them to breathe

What is the purpose of surface EMG?

Increases patient awareness of muscle movements during swallowing Match a target performance Can teach effort and maneuvers

Describe the Positive supporting reaction?

Infant makes automatic stepping movements when suspended vertically

How is the super supraglottic swallow performed?

Inhale and hold your breath tightly 1. Bear down 2. Keep holding your breath while bearing down while you swallow 3. Cough 4. Swallow again

Describe step 1?

Integral Stimulation patient watches and listens to clinician and imitates

What are the approaches for individual sounds based on Rosenbek and LaPointe?

Integral stimulation, phonetic placement, and phonetic derivation

What are the measures obtained from sentence tasks?

Intelligibility (%) Speaking rate (WPM) Rate of Intelligible Speech (IWPM) Rate of Unintelligible Speech (UWPM) Communication Efficiency Ratio

Describe Prepractice?

Intended to prepare learner for practice session

What did Yorkston & Beukelman investigate?

Investigated intelligibility and prosody in 4 ataxic dysarthrics "treatment of the complex, inconsistent...patterns of articulatory breakdown, laryngeal control, and respiratory support necessitates measurement of overall performance in which coordination of all speech mechanism components is involved"

What did McHenry 2003 do?

Investigated the effect of pacing strategies on the variability of speech movement sequences in dysarthria

What does multiple system atrophy involve?

Involvement includes neuronal loss and gliosis in BG, SN, cerebellum, middle peduncles, pontine nuclei, CS tracts, and anterior horn cells.

What is IOPI?

Iowa Oral Performance Instrument

Describe Language Production in RHD?

Is characterized by unusual language behavior: impairments of attention, perception, and organizational skill

What is the purpose of assessment?

Is there a problem? What kind of problem? Is it dysarthria? If so, what kind? Is the problem amenable to treatment? Stimulability testing What is the impact on function? To what extent is the dysarthria a handicap?

What questions are asked for physiologic support?

Is this necessary or appropriate? If so, which physiologic processes are necessary to support the problems identified?

General assessment of patients with TBI

It is critical to gather a comprehensive case history, observe the client, interview family members and healthcare workers, and review medical records to understand the nature and extent of TBI

what do you assess for function of oral motor evaluation?

Jaw lip movement lingual function velar function

How does the oral mechanism continue to function as a unit?

Jaw and tongue movements may occur simultaneously. Lip closure occurs only with jaw elevation. •

How does the damage affect innervation of LMN?

LMN is not innervated by UMN, when they are innervated, some of the gamma motor activity is inhibited. So excessive information is sent and there is an increase in muscle tone and increased resistance to passive stretch.

What is part I of the shaker exercise?

Lay flat on your back on the floor or bed. Hold your head off the floor or bed looking at your feet for one minute. Don't raise your shoulders off the bed or floor when lifting your head. Relax for one minute and repeat two more times.

List the exercises?

Lip Exercises Resistance Exercise-lips Buccal exercises Range of motion tongue exercises Resistance tongue exercises Posterior Lingual Elevation Bolus control Range of Motion for Pharyngeal Structures (VC adduction, valsalva) Tongue base retraction exercises Pharyngeal Clearance Exercise Laryngeal elevation Shaker Exercise Awareness of bolus swallow Thermotactile stimulation

Improve specific anatomy and/or physiology Eliminate or control prolonged aspiration Provide nutrition and hydration non-orally Medications to improve swallow function

List the medical interventions?

What language modalities do we evaluate?

Listening, speaking, reading, writing and naming. Also assess nonverbal communicative skills such as hand movements, facial expressions, etc.

What are the Possible that the organization of sensory information guides flexible and fluent movement patterns?

May be a factor in speech development Children with minimal oral feeding develop speech if they engage in oral exploration and are exposed to multiple sensory inputs of (nonfeeding) texture, temperature and taste Children who are unable to engage in any kind of oral exploration due to severe oral hypersensitivity may lack the necessary oral sensory experience. May lead to a paucity of sound production and severe delays in speech development

What are the principles of management of AOS?

Management should start early Baseline data Physiological support Principles of motor learning Self learning and instruction Feedback Specificity of training

Describe Papillary reactivity at admission in regard to prognosis for recovery?

Many patients whose pupils do not react during the first 24 hours of coma either die or become vegetables. Patients with reactive pupils have a 50% chance of a good recovery or only a moderate disability.

What is the goal of treatment?

Maximize swallow function through implementation of a comprehensive management program

When would we use an AAC for ALS?

May be able to use their hand in the beginning. Maybe introduce a device in stage 2.

What is done with patient's with severe AOS?

May be necessary to focus on syllable, sound and/or nonspeech tasks Learning to plan, execute, evaluate and self-correct oral movements, sounds in isolation, and meaningless syllables may be a necessary precursor to meaningful speech

What does multiple system atrophy(progressive supra nuclear palsy) result in?

May result in hypokinetic, ataxic or spastic speech symptoms.

What is the treatment of individual sounds for dysrathria?

May use standard articulation techniques

What areas will you target?

May work on separately or at the same time.

Name some standardized aphasia tests?

Minnesota Test for Differential Diagnosis of Aphasia, Boston Diagnositc Aphasia Examination, Western Aphasia Battery Revised, Neurosensory Center comprehensive Examination for Aphasia, Porch Index of Communicative Ability, Examining for Aphasia- 4th, Aphasic Diagnostic Profiles

What are the surgical interventions for hypokinetic dysarthria?

Palidotomy, thalamtomy, and deep brain stimulation

Describe Alzheimer's disease

Most frequent cause of dementia Neurofibrillary tangles- triangular and looped fibers located within nerve cell bodies. The tangles appear early in the disease and contain a protein called tau. Neuritic plaques- remains of degenerated nerve fibers located outside of neurons. Location of pathology expands as the disease spreads. It begins with the tangles in the hippocampus then infiltrates frontal, parietal and temporal lobes.

What is progressive supranuclear plasy?

Multisympton neurodegenerative disease often mistaken for Parkinson's Disease unknown etiology

What are the principles of motor learning?

Must be intensive and extensive drill in order to regain or learn lost speech skills Drill is intensive and extensive when many responses occur during each of frequent treatment sessions

What is the purpose of surgical interventions for hypokinetic dysarthria?

Neurosurgery - reduces activity in overactive brain structures Over excitation because basal ganglia is not inhibited.

Describe stage IV?

New movements are learned at the cortical level, although the execution of automatic and routine feeding and speech patterns are mediated at a subcortical level.

Describe number of items in cognitive stimulation?

One key feature of a therapy task is the number of items a. The specific words don't matter as long as the process is exercised (training sufficient exemplars). b. Same stimuli should not be used over and over again: rather, different stimuli at a comparable level of difficulty are presented to elicit responses (e.g., You buy a _____, You wreck a _____, You fix a ______) c. Thus, more likely to generalize

what are the characterists of hyperkinetic?

Orofacial dyskinesia: abnormal, involuntary, rhythmic or nonrhythmic movements of the orofacial muscles myoclonus: involuntary, rapidly occurring jerks of body parts, single or multiple muscles tics: commonly of the face and shoulders, patterned, rapid, and stereotyped chorea: purposeless, random, involuntary movements of the body parts athestosis: slow, writhing, purposeless movments, dystonia: contractison of antagonistic muscles that cause abnormal postures, spasmodic torticollis, bleharospams, tremor: rhythmic movments

How would you assess functional communication? Be cognizant of the information you would need as an SLP in order to make a diagnosis and therapy decisions. ?

Overall, it is important observe the patient's ability to convey or receive a message to or from the people around him. Functional communication includes many modalities not just speech. A person may be able to communicate functionally through an aid like a communication device or gestures. The important thing is that the person is able to do it independently. For example, just saying yes or no in response to a question is not functional communication. In order to make a diagnosis and therapy decisions the patient's social communication ,communication of basic needs, planning abilities, activities of daily living, reading, writing, and general functional performance.

Describe Primary Progressive Apraxia of Speech

PPAOS insidious onset and slow progress, contrasted wit stroke-induced AOS, sudden onset, some improvement and stabilization if the recovery is incomplete confused or subsumed under nonfluent primary progressive aphasia can occur without aphasia

What is the biggest predictor of recovery?

PTA duration predictor of recovery: the shorter the better (a temporary period of diminished awareness around the accident; pts cannot remember events occurring before/after accident)

Describe the prosthetic methods for VP Function?

Palatal lift determine candidacy evaluate effectiveness/document improvement

What are the lip resistance exercises for maintaining pucker?

Patient tries to maintain position against clinician's attempt to form lips into smile

List goals for a treatment plan?

Patient will tolerate least restrictive diet with no overt signs or symptoms of aspiration. Patient will tolerate PO trials for initiation of diet as indicated post instrumental assessment. Patient will perform Mendelsohn maneuver for 10 repetitions with moderate verbal and tactile cues for increased laryngeal elevation. Patient will perform lingual ROM and strength exercises against resistance with 10 repetitions for increased lingual lateralization and elevation.

Describe self-learning and instruction?

Patients should be urged to monitor their speech errors and self-correct Important to identify productive self-cueing strategies

Describe osciloscopic feedback?

Patients were given instruction to "fill up" window with certain amount of speech Forced speakers to slow down No other specific instructions given Read something and then not have four seconds of silence.

Describe Duration of optimal recovery?

Patients who recover most of their functions do so within the first 6 months post-injury.

Describe Drug abuse and alcoholism in regard to prognosis for recovery?

Patients who were intoxicated or had used illegal drugs before or at the time of accident suffer greater degree of brain trauma, partly due to secondary consequences of edema, cerebral hypoxia, and hemorrhage.

What is the treatment for phonation in flaccid dysarthria?

Patients with adductor paralysis may be candidates for medicalization surgery or VF injections to increase mass In some cases, amplification is the most practical solution of a reduction in loudness VF exercises are indicated for those with a stable course

Describe Type of injury in regard to prognosis for recovery?

Patients with diffuse injuries, especially with diffuse axonal injuries, recover less and slower than those with focal injuries. Patients with brainstem injuries have a poorer prognosis than those without. Also experiencing poor outcomes are those with intracranial hematoma (formation of a blood pool due to ruptured vessel) and increased intracranial pressure. (open head injury worse than closed..)

Describe Severity of injury in regard to prognosis for recovery?

Patients with more severe injury recover more slowly and to a lesser extent than those with less severe injury. Diffuse swelling have better level of recovery than those with additional DAI (diffuse axonal injury) because swelling subsides with time

Describe Secondary injuries in regard to prognosis for recovery?

Patients with secondary injuries recover more slowly and to a lesser extent than those without such injuries. Those with injuries to the respiratory or circulatory system resulting in low oxygenation of blood and lowered blood pressure fare much worse than those without systemic injuries.

How frequently do the buccal exercises need to be repeated?

Perform 10 repetition/3x day Frequency and duration based on client Can send them home with this

how frequently should the masako maneuver be performed?

Perform 10 times/ 3 times a day May use gauze to hold clients tongue during performance

How frequently is the shaker exercise performed?

Perform 3 times a day/6 weeks

What are the most common deficits in visuo-spatial perception (incl. Reading and drawing)?

Performance on the WAIS (Wechsler Adult Intelligence Scale) showed a pattern reversed to aphasia a. RHD's Performance IQ (i.e., visuospatial recognition and reasoning skills) was lower than verbal IQ Left hemianopsia: sensory impairment affecting the ability to see the left of center Visuospatial Attention, v isuospatial expression

Why do you need two people to administer and score the AIDS?

Person who gives it and person who scores it cannot be the same There are boxes that represent plates with 12 words. Will chose the word. Will read or imitate. Will pick a word from the 12 and then have them say it and have the other person transcribe the sample or select the word from one of the 12. With someone who is so unintelligible that they wouldn't't be able to transcribe, you would have them circle the word. Not looking for errors, but how close were they to what was said.

What does the cerebellum do?

Plays major role in mainatining muscle tone and coordinated movement synchrony is critical in coordinating finely controlled, rapid voluntary speech movements influences both posture and voluntary movement cerebellum receives info from the cortex re: initiation of movement so that it can make appropriate adjustments in muscle activity information from muscle spindles and golgi tendon organs assists in maintaining appropriate muscle tone

Describe how communication boards can be used to facilitate communication?

Pointing behaviors, menu, shopping list, compensatory materials and strategies.

What are the prosthetic managements for respiratory function?

Portable amplification= cant tolerate getting much louder, those who fatigue

why would you see intelligibility increase but rate decrease?

Possible that as a part of therapy they used slowed speech to help intelligibility. Rate did end low. Good way of showing progress

What are the types of compensatory treatments?

Postural techniques Food modifications Bolus size Speed of presentation Prosthetics

Describe postrual triggers in pseudobulbar palsy?

Postural triggers: when in a certain position may be more affect. Cough and then start crying or something of that nature.

What is the structure of practice based on Maas?

Practice amount (large vs. small) Practice distribution (massed vs. distributed) Practice variability (variable vs. constant) Practice schedule (random vs. blocked) Movement complexity (simple/part vs. complex/whole)

Describe blocked practice?

Practice schedule in which learner practices a group of the same target movements before beginning practice on the next target

Describe the motor planning stage?

Proposed to occur in the motor association areas, including premotor area, Broca's area, supplementary motor area, prefrontal and parietal association areas, caudate circuit of basal ganglia, and Wernicke's area Model assumes that the phoneme is the basic unit of planning Motor plans are articulator-specific (not muscle-specific). The movement parameters (i.e., invariant spatial and temporal specifications) for each sequence of phonemes being planned are adapted by the context in which they occur.

How is the general pragmatic use of language of aphasic pts? Do these patients only understand literal meaning?

Pragmatics: the study of natural language use; relevant observation consists of language behavior in relation to context (i.e. comprehending a speaker's intent and repairing a defective utterance in conversation.) When investigating aphasics abilities of inferencing (making nonliteral interpretations) one study found that nofluent and fluent aphasic groups had fairly moderate-mild impairments determined within the WAB; thus they may have some trouble arriving at a full interpretation of a speaker's intended meaning. No they do not only understand literal meaning, some investigators have supported the conclusion that aphasia does not impair the capacity to make nonliteral interpretations. For example, they understand that "Can you open the door?" is a request to open the door, and not a Yes/No question.

Describe the Tonic neck reflex ('fencing posture')?

Present at one month of age and disappears at around four months When the child's head is turned to the side, the arm on that side will straighten and the opposite arm will bend Believed to be a precursor to the hand/eye coordination of the infant and to prepare the infant for voluntary reaching

Describe Frontal Cortical Atrophy

Primary progressive aphasia (PPA) and Non-Alzheimer lobar degeneration

What are the speech programming problems/ dominant symptoms of apraxia?

Problems in volitional or spontaneous sequencing of movements required for speech high variability of speech errors with changing patterns of errors on repeated attempt spech sound substitutions (more common than disotrtion and omissions) voicless for a voiced pronounced difficulty with consonatns (affricats, fricative, consonant clusters) anticipatory substitions postpositioning errors metathetic errors insertion of a schwa into consonant cluster increased frequency of errors on longer words trial and error gropping and struggling associated with speech attempts greater difficulty with word intial sounds easier automatic prouctions attempt at sef correction

What is the emphasis on high effort and multiple repetitions?

Program is intense (4x/week for 1 month Requires high levels of physical effort to increase loudness and VF adduction Exclusive focus on respiratory-phonatory effort (as opposed to resonance, articulation and prosody)

Describe Progressive Dementias

Progressive- due to disease Alzheimer's Disease Bilateral parietal and temporal lobes (including hippocampus) Accumulation of neuritic plaques and neurofibrillary tangles Lewy Body Disease Frontal and temporal lobes; basal ganglia Protein deposits (i.e. Lewy bodies) in neuronal cells Frontotemporal Dementia (FTD) Frontal lobe degeneration; more temporal lobe atrophy than in Alzheimer's disease Absence of plaques; presence of tau protein ("Pick's bodies") Parkinson's Disease Subcortical dementia; substantia nigra in the brain stem Cell loss reducing production of the neurotransmitter dopamine Huntingtion's Disease Subcortical dementia; caudate nucleus of the basal ganglia Inherited atrophy of the caudate

What is prepractice important to insure?

Proper motivation to learn Functionally-relevant treatment targets Improved by setting specific goals rather than asking learners to "do the best they car"\ Adequate understanding of task Includes what responses are considered "correct" Stimulability for acceptable responses Avoids frustration

Describe coordination problems in ataxia?

Prosodic patterns may contribute to impression of "bizarreness" in dysarthria Focus is mostly to improve intelligibility and "naturalness" by modifying rate and prosody

What does the oral motor evaluation do?

Provides information about size, strength, symmetry, range, tone, speed and accuracy of orofacial movements

What is the criteria for establishing respiratory support?

Ps is <3 cm-H2O on speech tasks Ps cannot be sustained for > 2 seconds exceedingly short breath groups (i.e., 1-3 seconds)

How are lip exercises performed?

Purse your lips and protrude as far forward as possible and hold. Pull your lips back into a wide smile and hold. Smack your lips together forcefully.

How are resistance tongue exercises performed?

Push tongue to popsicle stick Lateral movement Protrusion Hold for 1+ seconds Providing the resistance.

Why is the depressor important?

Put it between their lips and pull so they will resist, pressure, bolus formation- helps maintain the shape of bolus formation

What are the two types of hyperkinetic dysarthria?

Quickness or slowness of involuntary movements

Describe Communication Efficiency Ratio?

Rate of intelligible speech (IWPM)/mean rate of intelligible speech produced by a group of normal speakers (190 IWPM)

What are tests of reading skills?

Reading Comprehension Battery for Aphasia-Second Edition, Nelson-Danny Reading Test, Gates-MacGinitie Reading Test

Describe assessment of Reading and writing difficulties?

Reading and writing tasks such as client specific tasks as having the client read familiar print, write to dictation, or copy printed material will help assess these difficulties

what is the purpose of swallowing signals lab?

Real time displays of critical parameters of swallow function Visual and auditory feedback kpentex

Descirbe LVST?

Recalibrating the sensory Based on principles of motor learning Good efficacy data Emphasis on high effort and multiple repetitions

Describe the language and cognition changes in Stage 3 Late Severe stage of Dementia

Recent events fade fast Remote memory impaired Family not recognized Incontinence Neuromotor disability appears Becomes unresponsive Becomes mute

Describe the language and cognition changes in Stage 2 Middle Moderate stage of Dementia

Recent events forgotten Math skills reduced Memory impairments more obvious and disruptive (shoes are put on before socks) Comprehension reduced Paraphasias, jargon Irrelevant talk Naming becomes wordy Poor self-monitoring

Describe what should be stable for VF exercises?

Resonant voice therapy Vocal function exercises Semi-occluded vocal tract exercises

What are the areas of treatment for individuals with dysarthria?

Respiratory function Phonatory function Articulation Velopharyngeal function Rate/Prosody Strategies for improving intelligibility

Describe Reversible Dementias

Reversible- cause can be treated to restore normal cognitive function -Depression -Alcohol abuse - Drug toxicity - Polypharmacy- the simultaneous use of multiple medications which can promote declining intellectual function -HIV/ AIDS N/A N/A The cause can be treated to restore normal or nearly normal cognitive function.

What are the normal components that lead to feeding and speech?

Rhythmical patterns may be impeded by increased muscle tone and abnormal movement patterns. Low tone and poor proximal stability interfere with the controlled development of distal movements. Oral mechanism continues to function as a unit. Options creating variability and flexibility in the oral-motor system are limited. The infant possess minimal sensorimotor components to deal with complex feeding tasks and elaborated sound play.

Describe right hemisphere disorders?

Right-hemisphere brain damage or right hemisphere syndrome Include attentional (perceptual) and affective symptoms Communication deficits in 50-78% Impaired attention, impulsive behavior, pragmatic communication impairments, and visual neglect. -right hemisphere functions are more diffusely organized than left hemisphere functions -right hemisphere syndrome varies in symptom complex, posterior lesions do not produce motor problems whereas frontal lobe injury do. -patients with frontal lobe injuries are hospitalized longer than those with posterior lesions

Is spasticity paralysis?

Rigidity=/= spacicity- don't have paralysis. Try to passive movement, there is cog whelal regidit, like a rachet. Clasp knife rigidity: such as when you are trying to close a knife and there is a lot of resistence in the beginning and minimal after you get past a certain point.

How are buccal exercises performed?

Round lips tightly for "oh"-hold for 1 second Stretch lips broadly for "ee"-hold for 1 second

What is the meaning of treatment Efficacy?

SLPs are minimally required to document whether a patient is progressing during the period of treatment Three "effs" of accountability in clinical practice c. Effort: is documented as the number of patient visits and the length of visit d. Efficiency: is a measure of effort with respect to time (e.g., visits per day) e. Efficacy: the effect of a treatment on recovery of language skills i. Working hard and efficiently does not guarantee the third eff, efficacy There are differing opinions on the difference between efficacy and effectiveness A generalization probe per se does not provide evidence for efficacy or effectiveness of treatment because other factors could account for progress any time post onset (e.g., neurological changes, medications, living environment, other activities) Those who receive therapy show more improvement than those who do not receive therapy (Tx is generally effective)

Describe Deep brain stimulation (DBS)?

Same goal as for Pallidotomy and Thalamotomy Stimulators placed in thalamus, globus pallidus or sub thalamic nucleus Activated by handheld magnet Results for speech are variable Some evidence that language is impacted

What is the cause of hyperkinetic dysarthria?

Seen in association with a variety of extrapyramidal disorders in which abnormal involuntary movements of the limbs, trunk, neck, face, etc. disturb the rhythm and rate of motor activities, including those involved in speech production. degenerative disease, vasular diseases, trauma, toxi or metabolic condtions

Describe stage 2?

Separation of tongue and lip movements from jaw movement appears in feeding but not in sound play.

Give characteristics of Wernicke's Aphasia

Severe fluent aphasia, normal or abnormal fluency (logorrhea/ press of speech) normal phrase length rapid rate of speech intact grammar word finding problems paraphrasias (semantic and literal) neologism, extra syllables circumlocution empty speech poor auditory comprehension impaired conversational turn taking impaired repetition reading and writing problems difficulty recognizing sounds associated with written words and meaning meaningless writing, frequent misspellings, neologistic writing poor communication in spite of fluent speech Dissociation of word finding from syntax Poor therapeutic set, don't realize why they are with an SLP. paragrammatism pure word deafness (due to sol) Damage to temporal and parietal areas too Fluent phonemic paraphasias in Wernicke's and inferior parietal, lexical paraphasias more posterior angular gyrus and occipital, jargon from posterior lesions If damage is further back in brocas, tend to be more severe, further back in wernickes, more severe. • Disconnection between meaning and sounds Do better with visual language • Object classification is poor. • When given a category, they may include high and low typicality words,

What are the findings of LSVT for individuals with Parkinson's disease?

Shown to decrease rate in individuals with Parkinson's Disease.

What is semantic paralexia?

Similar meaning- coast for seashore.

Describe replicating sensorimotor development?

Some models of movement development hypothesize that it "evolves from the organism's interaction with the environment and the pairing of sensory traces with the contributing movement." These interactions "form the basis of neural pathways within the nervous system that are preferentially reinforced by movements patterns and their sensory representations."

Describe establishing optimum rate and intelligibility relationships?

Speakers recorded passages unknown to the clinician Instructed to reduce rate so that speech was at least 95% intelligible When that was achieved, subject was encouraged to maximize rate without sacrificing intelligibility

what did moore et al find?

Speech activity in adults and children as young as 15 months was characterized by contraction of agonist-antagonist muscle pairs. In contrast, chewing for both groups was characterized by alternating activation of these same muscle groups. Thus, muscle activation patterns for speech appear to be adult-like and distinct from those seen in chewing at fairly early stages of speech production.

What are TIAS and infarctions?

TIAs are little strokes and infarctions is when the tissue behind the thrombosis dies.

What should we keep in mind (practical / realistic and theoretical issues...) when assessing apahsia

Take into account cultural biases of tests Avoid a diagnosis based on too few observations. (inconsistent responses) Silence/ unresponsive due to depressed or medicated. wait until the patient is alert and responsive • Look for common threads (e.g., problem with comprehension vs. production, comprehension of simple vs. complex sentences) when comparing the 4 primary language modalities. • When planning goals, prioritize according to the patients communicative needs. What will the person be motivated to work on? Work on topics that interest the patient.

Why is there no evidence that working on non-speech behaviors will affect speech?

Task specificity

What are the prinicples of behavior modification?

The Task: Select a behavior, be specific regarding acceptable forms. Model the desired response if necessary. • Feedback: Consequences of the behavior control the frequency of its occurrence. • Verbal praise: an incentive feed-back procedure. • Reinforcement Schedule: the rate of reward: continuous or intermittent. • Information feedback is often preferable

What is an ischemic stroke?

There can be a blockage/interruption of blood flow of an artery that supplies blood to the brain

What kinds of studies have been completed on AOS?

There have been few controlled treatment efficacy studies for treatment of AOS

taste on the anterior 2/3 of tongue - innervation

facial nerve via chorda tympani

Describe Speaking rate (WPM)?

Total number of words/duration of sentence sample in minutes (does not include intersentence duration)

What does feeding do for sensorimotor control?

The development of underlying features of rhythmicity, stability-mobility, separation of movement, guidance of sensory input and reversion to earlier movement patterns is seen in all motor control systems. Thus, feeding may provide a multisensory environment with frequent opportunities to organize and reorganize sensorimotor control.

How do we interpret our test results

The patient's test score should be compared to the normative data in order to determine if there is a communication disorder. However, clinicians should not base their diagnosis on test results because tests do not diagnose problems, rather people do. A test does not tell us that a person has aphasia, we interpret our observations according to what we understand aphasia to be, namely a disorder of language processing as opposed to hearing loss or level of consciousness. The test scores should be used to support our diagnosis.

The general effects of Frontal Lobe Syndromes on intellectual abilities and personality ?

The pre-frontal area is another region of the brain commonly damaged in CHI. Pre-frontal damage causes changes in intellectual skills and personality. Problems noted are attention disorder, executive dysfunction, amnesia, and personality disorder.

What is our purpose when testing a patient who has aphasia

The purpose of testing a patient is to answer the following questions: 1. Does the patient have a communicative disorder? 2. If so, is the disorder aphasia? 3. If so what kind of aphasic disorder does the patient have? 4. Does the patient have other disorders/ coexisting disorders besides aphasia? (agnosia, dysarthria, etc.) 5. Are the clinical findings consistent with the medical diagnosis?

Is this a normed reference?

There are no norms for tongue movement or strength of the tongue. So it will show your data from day one to day ten.

What will the type of dysarthria be based on?

The type of dysarthria will depend upon the site of lesion within the motor pathway.

Describe treatment of respiratory weakness in flaccid dysarthria?

There may be some benefit from strengthening exercises to increase physiologic support for speech breathing.

What did DAB do?

They concluded that dysarthrias resulting from damage to different parts of the nervous system can be differentiated according clusters of perceptual characteristics related to disturbances of one or more speech processes.

What does damage to the gamma motor neuron do?

This causes an increased responsiveness of alpha motor neurons, via the reflex arc, resulting in increased muscle tone and increased resistance to passive stretch

What is the neuropathology of Creutzfeldt-Jakob disease?

This disease is a widespread spongiform state in the brain; neuronal loss maybe found in cortical areas, the basal ganglia, thalamus, Brain stem, and spinal cord -physical symptoms include fatigue and sleep disturbances -neurological symptoms include cerebellar ataxia, Tremor, rigidity, chorea, athetosis, and visual problems -symptoms of dementia includes a memory problems and reasoning impairments -psychiatric symptoms include depression, anxiety, euphoria, hallucinations, and delusions -the final stages characterized by stupor, mutism, seizures, an pneumonia often lead to death

Elaborate on use of left side of signing space?

This is an indication that spatial attention is a special system occurs with ASL. One RHD patient that was studied "correctly used the left side of signing space to represent syntactic relations, despite her neglect of left hemispace in non-language tasks." Those (deaf pts) with RH damage didn't exhibit language problems (bc lang. is LH function whether spoken or signed).

What are some modifications of the shaker exercise?

Towel roll under the chin. Patients may not be able to be in this position because of a peg tube.

What is Continuous recognition memory task?

This is used to study duration of short-term retention. - In one type of test, a series of drawing are presented and some are repeated and the pt must say if the drawing is "new" or "old". - In studies of adolescents with CHI, short-term recognition memory varied as a function of severity of injury.

What is the Influence of the mandates of Managed Care on Aphasia Treatment?

This limits the number of treatments per patient. There are treatment caps that may be shared with physical therapy. The cap may apply to inpatient rehab, rehab centers and home health agencies. It may not apply to outpatient clinics in hospitals. (I've used the word "may" because we don't know what the current rules are.) It has put limits on the amount of treatment per patient.

What are the two general categories fo treatment for articulation?

Those that aim to normalize function by reducing impairment and production of individual sounds

How do we monitor the goals of treatment?

Through assessment recommendations and ongoing monitoring

What can we predict based off of the gestural theory

Thus, we might predict that the AOS reflects an inability to produce overlapping gestures, resulting in stress and rate changes. This hypothesis might motivate a treatment approach that focuses on relearning control of the articulators both within and across gestures and would provide a rationale for training across classes of sounds rather than isolated sounds training individual gestures in a range of contexts This approach "argues for training a single motor skill in a range of phonetic-motoric contexts to facilitate generalization of that skill to untrained exemplars."

What measures the tongue array?

Tongue bulbs look like a pouch with air. Those publes are pushed down and that is measuring how much pressure they generate. Can measure right and left elevation

What are some of the primitive postural reflexes?

Tonic neck reflex ('fencing posture') Positive supporting reaction Moro reflex (startle reflex) Sucking and rooting response

What are the characterisics of transcortical sensory

Transcortical sensory aphasia is like Wernicke's : good repeat, echolalia, lesion posterior to common language area (temporo-occipital area) apparently appropriate grammar and syntax paraphasic empty speech severe naming problems poor comprehension of repeat words impaired auditory comprehension difficulty in pointing, obeying commands, yes/no questions automatic speech spared tendency to complete sentences good reading aloud better oral reading skills than other languages generally better oral reading skills writing problems that parallel expressive seepch

Describe single word intelligibility?

Transcription or Forced choice

What do treatments focus on for flaccid dysarthria?

Treatments tend to be designed to increase strength or to compensate for weakness.

What is important to remember about elevation?

Trouble with elevation= hyoid and thyroid elevation and approximation, lengthening vocal folds, adducting. They will sound monotone.

What do we use compensatory treatment for?

We have compensation that is short term and then treatment to have a physiological change on the swallow.

What was the overall measures for Investigated intelligibility and prosody in 4 ataxic dysarthrics "treatment of the complex, inconsistent...patterns of articulatory breakdown, laryngeal control, and respiratory support necessitates measurement of overall performance in which coordination of all speech mechanism components is involved"?

Use overall measures of intelligibility as a means of making decisions that guide treatment sequencing

Describe rhythmic cueing?

Used as a transition from rigid rate control to self-monitoring Manual cueing of stressed and unstressed syllables Pacing boards have phrases and then you read it.

What are exercise used for?

Used to improve the extent of movement of the lips, jaw, tongue, larynx and vocal folds Permanent changes in the physiology of the swallowing mechanism

sequence of events from CNS to cranial nerves - step 4 - what nerves are activated in the oral phase? (3)

V, VII, XII

What is important to remember for tongue base retraction exercises?

Valleuclar residue, using yawn to relax and swallow== cricopharyngeous muscle is tight.

Aid in oral clearance and pharyngeal clearance.

What is the goal of lying down?

Describe Crossed Aphasia

Variation in functional organization of the brain, reversed asymmetry 70% are mirror images of typical left hemisphere damage phonological process or lexical semantic processes i.e. a right hemisphere storke is the left hemisphere

What is done for mute patients with AOS?

Vegetative actions such as grunting, coughing laughing and singing may be elicited reflexively and then shaped toward voluntary control as a precursor to meaningful speech Goals is to improve programming of volitional oral movements, not to increase strength or physiologic support

What is Attentional dyslexia?

Visual errors with the left or right side of words. Cannot name parts of visual arrays but can name them in isolation.

What is neuromuscular electrical stimulation?

VitalStim External electrical stimulation for swallowing Adjunct modality transcranial magnetic stimuluation transcranial direct current stimulation

What is the purpose of swallow maneuvers?

Voluntary control of pharyngeal swallow physiology Ability to follow directions Ability to maintain muscular effort

What are the tasks for speech assessment?

Vowel prolongation, alternating motion rates, sequential motion rate, contextual speech, stress testing, assessing motor speech programing

Define integral stimulation?

Watch, listen and imitate

What are etiologies of spastic dysarthria?

We expect very little due to the bilateral innervation, will not a have a significant dysarthria without bilateral damage. etiologies include CVA, tumor or head trauma

What are the findings of neuromuscular electrical stimulation?

We have seen some very positive results with this modality as supported in the literature, however, there has also been lack of or negative impact. Using clinical intuition and observation is necessary

Describe where we look for agrammatism

We look for agrammatism in the production and comprehension of sentences. 1. describe pictured actions or object locations, 2. complete a sentence or short story, 3. create a sentence given a noun or verb. 4. picture descriptions, 5. during convo

What are some of the Measures of Recovery of Language?

We may measure either clinical improvement in tasks used for clinical assessment or functional improvement in solving communicative problems of daily living o Most investigators have measured clinical language behavior with the Porch Index of Communicative Ability (PICA) and the Western Aphasia Battery (WAB). Includes amount, final outcome, rate, and pattern

Name the fluent aphasias?

Wernicke's, transcortical sensory aphasia (TSA), conduction aphasia, Anomic Aphasia,

with dicim= cup wont go anywhere. If they have tremors, less likely to knock over food. Or eating something that you need to keep the container or bowl still.

What are intraoral prosthetics good for?

Larger bolus may increase trigger of pharyngeal swallow Smaller bolus may eliminate aspiration Increased sensation and work.

What are some adaptive feeding utensils/feedback tools?

Reduced tongue coordination Delayed initiation of the swallow Reduced laryngeal closure (reduced laryngeal elevation and excursion) Used for patients with unilateral vf paralysis- poor airway build up

What are the gel based commercial thickeners?

Developed in 2002 by the American Dietetic Association Liquids are standard, but the diets are not very consistent. Many have used this standardized language

What are the goals of the national dysphagia diets?

Permanently opens sphincter

What are the issues with Cricopharyngeal Myotomy?

Simply Thick® Liquid Gel Thickener

What are the powder thickeners?

Reduced laryngeal closure, unilateral pharyngeal weakness, CP dysfunction, cervical osteophytes

What diagnosis is this used for?

Unilateral weakness to oral and pharyngeal musculature

What diagnosis is this used for?

delayed swallow, reduced tongue base retraction, reduced laryngeal elevation

What diagnosis is this used for?

liquids must be taken by straw Stay towards your esophagus rather than by trachea.

What diagnosis is this used for?

Postural techniques Food modifications Bolus size Speed of presentation Prosthetics

What do the compensatory treatments do?

Stretching of scar tissue. Catheter and is placed and sometimes they can inflate them. May see it go, stop and then drain. Sometimes it is effective longer. Effective 1-3 months Not effective for CP dysfunction due to neurologic damage

What does Cricopharyngeal Myotomy do?

Establish standard terminology and practice applications of dietary texture modification in dysphagia management

What is NDD1?

mashed potatoes, apple sauce, pureed meats, pureed vegetables/fruits, pudding

What is NDD2?

Chopped Cut to the size of a dime, require some chewing, but all cooked and processed, not raw. Always have a condiment- gravy, ketchup, mayo

What is NDD3?

Poor mastication but movement is good for chopped- don't masticate, but form to bolus NDD#- is effectively masticating soft solids. Not good for someone who would pocket the food. Reduced tongue based retraction and oral clearance- harder consistency with residue.

What is bite-cut regular?

surgical reduction of cervical osteophytes, vocal cord adduction, dilation of scar tissue, Cricopharyngeal Myotomy, Epiglottic Pull-Down Suturing vocal folds together, Suturing false vocal folds together, Tracheostomy, Total laryngectomy

What is cervical osteophytes?

Considered when traditional treatment programs and strategies are ineffective Temporary injection: gel based (glycerin) Injecting earlier. Before it was just 3-4 months post.

What is dilation of scar tissue?

Reduced pharyngeal wall contraction (bilateral), Reduced laryngeal elevation

What is important about lying down?

permanently opens the sphincter

What is the criteria for selection?

Can use during evaluation and during treatment and beyond Before we modify consistencies we want to change the physiology of the swallow

What is the drawback of postural techniques?

Just lifting the chin. If they have a tracheostomy tube, this would be more comfortable, patients that have head control or those who are lying down, stiff neck or cervical impairments, aspen collar

What is the goal of chin down?

While they chew Effective for those with reduced tongue propulsion, oral cancer, Not good for someone who is able to contain in their mouth. Especially with delayed swallow, those with premature spillage;

What is the goal of chin up?

Modeling and errorless learning. If they are impulsive- limit the amount you give them at a time. Educate patient's families, make them do it explain side effects of strategies, show or share a success story.

What is the goal of head back?

1. Take a sip and hold in your mouth. 2. Touch your chin to your chest. 3. Swallow

What is the goal of head rotation?

Cardiac surgery, pontine stroke, traumatic intubation. Cervical osteophytes- arthritic changes in the spine. Head rotation will change the anatomy to bypass the cervical spine

What is the goal of head tilt?

nerve damage and scar tissue. Rare to do surgical reduction; swallow is mostly impacted when there is a secondary event that affects the swallow physiology. Rather do compensation.

What is the goal of vocal cord injection?

surgical reduction to remove excess bone

What is the issue with the surgical intervention?

4 8oz bottles to have the same as 8 oz

What is the national dysphagia diets?

Used for oral cancer patients with resection of the soft palate

What is the palatal augmentation?

palatal lift, palatal obturator, palatal augmentation

What is the purpose of a palatal lift?

Lifts the soft palate into an elevated position Speech and swallowing.

What is the purpose of a palatal obturator?

Increase tongue to palate contact Maxillofacial prosthodontist Within 4-6 weeks post surgery

What is the purpose of medical interventions?

What is the important question about articulatory imprecision?

What is the relationship between movement abnormalities and perceptual measures of articulatory adequacy? Example: cant resist movement, weak tongue in frencahy;

bonny overgrowths on the cervical vertebra

What is the surgical reduction for cervical osteophytes?

Change the effect of gravity on the pharyngeal swallow

What physiological impairment is this used for?

Increase airway protection (increases vocal cord adduction, narrows airway opening); Increase UES opening (pulls cricoid cartilage away from posterior pharyngeal wall reduced resting pressure in CP sphincter); Clear pharyngeal residue

What physiological impairment is this used for?

Increase oral and pharyngeal clearance

What physiological impairment is this used for?

Increase vallecular space to prevent bolus from entering airway, increased tongue base to pharyngeal wall contraction, narrows airway entrance

What physiological impairment is this used for?

to clear food from oral cavity

What physiological impairment is this used for?

What questions are asked for intelligibility?

What would help intelligibility the most?

Someone who doesn't't have a swallowing impairment but motoric limitations. Pre cut for the individual. Also a GI soft diet= gi bleed or ulcer and physician recommend that they have soft food. No raw veggies or crackers or chips that would cause problems in the intestines. Also a dental soft diet for those who are edentulous but can still eat ; not related to dysphagia. Recommend and refer for OT evaluation

What's important to remember when modifying bolus size and speed?

Each postural change is unique to the individual and swallow impairment Head and body postural changes may be effective in eliminating aspiration of liquids in 75-80% of patient Used during evaluation and chosen to best fit the patient's physiologic need

When can we use postural techniques?

Describe RHD patients relied on denotation more than connotation?

When choosing the most similar pair of words in a triad (e.g., loving, hateful, warm), RHDs relied on denotation (e.g., loving—hateful), more than connotation (e.g., loving—warm). Aphasics relied more on connotation than denotation

Good for ALS- progresses to postural weakness.

When should food consistencies be changed?

Slower moving, able to maintain form. Recruits more muscular effort to overcompensate. liquid flows off a spoon in a ribbon, just like actual honey

Who is honey thick best used for?

Remain on the spoon in a soft mass, Pureed consistency Spoon in the middle= will stand straight up

Who is spoon thick best used for?

Increases the size of the pool to fill the vallecular space and gives more time to initiate the swallow. Allows for the posterior pharyngeal wall and tongue base to approximate.

Who is this not appropriate for?

Why does paralysis occur with flaccid dysarthria?

With no motor impulses from the lower motor neuron, the muscle fibers are completely paralyzed for voluntary movements.

Describe the nature of the sensorimotor experience?

With respect to articulation, the nature of the sensorimotor experience is important in the development of relevant neural control. In other words, "if sensorimotor stimulation is to foster speech, then speech like activities such as sound play and stimulability training" must be used.

What happens with the loss of dopamine-producing neurons?

With the loss of dopamine-producing neurons, the globus pallidus becomes overactive, resulting in inhibition of the VL nucleus of the thalamus. As a result, there is reduced excitation of the cortex. This leads to a condition called hypokinesia.

Describe how naming may be deficient?

Word-finding deficits unique to semantic categories also point to anomia. - If the disorder is lexical, object sorting and word comprehension are okay. - Anomic pts have intact semantic systems but have occasional difficulty accessing an entire lexical form ("access to phonology was found to be almost an all-or-none phenomenon with anomic patients.)

Define dysarthria?

a collective name for a group of related speech disorders that are due to disturbances in peripheral or central nervous system pathology resulting in muscular control , paralysis, weeknes or incoordination(weakness, slowness, or incoordination) of the speech mechanism due to damage to the central or peripheral nervous system or both.

Define apraxia according to strub and black 1981?

a disorder in carrying out or learning complex movements that cannot be accounted for by elementary disturbances of strength, coordination, sensation, comprehension, or attention

Describe Attention impairment in TBI?

a. Especially focused and dived attention b. Patients have increased distractibility c. Anterior communicating artery aneurysm (ACAA or AcoA or AACA):

What is limb apraxia?

a disorder of skilled movement that cannot be attributed to paralysis. A movement can be performed in natural circumstances but not when a patient is asked to perform the action occurs mainly when there is damage to the left parieto-temporal lobe boundary. Pts often do not have hemiplegia. Evaluation is usually done in conditions of imitation, movement on command, and natural or spontaneous movement. body-part-as-object (BPO)- puffing between fingers as if holding a cigarette body-part-as-tool (BPT)-using finger to brush teeth.

Define Apraxia?

a form of motor agnosia; a motor planning disorder, not a motor weakness disorder; Is a neurogenic speech disorder of volitional movement in the absence of muscle weakness, paralysis or fatigue

Define apraxia according to Crary 1984?

a group of phonological disorders resulting from disruption of central sensorimotor processes that interfere with motor learning for speech... Paralysis or weakness might be present, but is not sufficient to account for the nature and severity of the observed speech disorders

Give an example on nontypological?

a loss or impairment of language caused by a recent brain injury. comprehension and expression of language, along with reading and writing, may be impaired.

what is dementia?

a major health problem primarily found in people 65 years and older. acauired neurological syndrome associated with persistent or progressive deterioration in intellectual functions, emotions, and behavior.

Praxis definition of aphasia?

a neurologically based language disorder

Describe the motor programming stage?

a set of muscle commands that are structured before a movement sequence begins which can be delivered without reference to external feedback' Programs specify muscle tone, movement direction, force, range, rate and mechanical stiffness of joints.

What is meant by functional outcome?

a term that is currently used to refer broadly to the benefits of medical and clinical treatments. (What skills can we bring back to optimize quality of life given the retraints of the pt.can they function alone? can they return to work?). Outcome measurement has become the means of documenting whether functional therapeutic objectives are being attained

what is an embolus?

a traveling mass of arterial debris or a clump of tissue that gets lodged in a smaller artery. (such as fat from the heart)

How is paired associate learning task tested?

a. Explicit test: consists of presenting the first word of a pair (e.g., window--) to see if the pair word is remembered. i. Subject is aware that memory is being tested ii. Prior to the explicit test, the subject is also given a word stem completion task that can be done without prior exposure to the list (e.g., rea____) iii. With awareness that prior learning or memory is being tested ("conscious") b. Implicit test: Seeing if a subject completes stems from a list more accurately or faster than stems not in the lists i. Without awareness that prior learning or memory is being tested ("unconscious)

What are the general strategies to improve communication (aimed at disability and handicap)?

a. Maximize use of residual linguistic capacities b. Develop augmentative or alternative modes of communication c. Maximize psychological and emotional adjustment to language impairment, d. Improve the role of partners and settings in facilitating communication e. These factors influence, interact with each other positively.

Describe how RHD affects lexical-semantic system in an interesting way?

a. Patients experienced pronounced priming effect for combined phonological-orthographic relatedness (e.g., prime: look, target: book) with 250 ms interval between prime and lexical decision target. b. If prime does not affect the response time it is neutral c. RHD patients performance was not facilitated when the prime was a face

What is PACE Therapy?

a. Promoting Aphasics' Communicative Effectiveness (PACE): a strategy for interaction can be modified from the basic naming task to incorporate the features of face to face conversation

What is Mental Imagery and RHD?

a. RHD patients have difficulty with drawing, and image generation is also deficient b. Quasi-pictoral representation in the form of percepts held temporarily in a visuospatial buffer, or structural descriptions of objects or scenes activated in long term memory c. Difficulty with object centered 3D percepts, i.e., matching objects in unusual views (e.g., tasks of mental rotation such as matching a flag with one of a set of rotated flags - ((if you see a shoes from above you may not be sure if it has a heel...how do you need to rotate it or view it to see more of it)) d. ****The linguistic use of space is a different process from the non-linguistic use of space****

Elaborate on the usefulness of Aphasia batteries with RHD?

a. The reason is because most RHD patients are non-aphasic in that they can normally process most words and sentences in isolation b. In addition, someone with RHD makes mistakes on language tasks for other reasons other than having a language disorder or aphasia i. Impairments of perception and attention may be the underlying causes of the extra-linguistic, linguistic and nonlinguistic deficits manifested by patients with RHD. c. However, the aphasia battery does highlight that patients with RHD do not always escape difficulty with some language-related activities d. As stated above, right hemisphere patients typically do not have the kinds of language problems seen in aphasia. However, as some do have specific linguistic problems, RHD patients should be given an aphasia battery

What is needed to perform the exercise?

ice and a size 00 laryngeal mirror

Define Oculomotor apraxia?

ability to control visual tracking is impaired

What do you asses for jaw?

ability to open jaw and maintain good closure

Define hyperkinetic dysarthria?

abnormal involuntary movements

Define fasiculations?

abnormal movement of individual muscle fibers.

Describe Abnormal sensory integration?

abnormal organization and interpretation of sensory information may interfere with development of oral-motor patterns sensory aversion/defensiveness may also trigger abnormal motor patterns deprivation of oral sensory experiences may interfere with development of sensorimotor integration needed for

What are the characteristics of dysarthrai?

abnormal strength, speed, range, steadiness, tone, and accuracy of movement. may be evident in respiration, phonation, articulation, prosody, and resonance. all aspects of speech production may be affected.

What is Nystagmus?

abnormal, rhythmic oscillation of the eyes represents damage to vestibulocerebellar system http://www.youtube.com/watch?v=phpe_RVGqcA

What does supranuclear mean?

above the level of the cranial nuclei

What is Masked faces?

absence of change of facial expression.

What are the characteristics of TMA?

absent or reduced spontaneous speech nonfluent, paraphasic, agrammatic, telegraphic speech intact repetition skills echolalia and perseveration awareness of grammaticality refusal to repeat nonsense syllables use of unfinished sentences limited word fluency use of simple and imprecise syntactic structures attempt to initiate speech with help of mtoor activities good comprehension of simple, impaired complex slow and difficult reading outloud seriously impaired writing

CN XI

accessory

Describe DAT?

accounts for 60-70% two subtypes: early onsent AD and late onset AD more woman then men affected associated with a family history of Down syndrome, prior brain injury and low level of education genetic inheritence accounts for some

Describe the disorder of apraxia of speech?

affecting the translation of an intact phonological representation of a message into the learned kinematic parameters for an intended movement that manifests itself at both phonetic and phonological levels involves spatio-temporal disruptions due to articulatory discoordination reflects impairments of intraarticulatory control, interarticlator coordination and transitioning between articulatory gestures

What does abnormal oral motor development do to speech?

affects the normal components that lead to efficient feeding and speech

How can the distinctions help with recognizing the dysarthrias?

aids in the localization and diagnosis of neurologic disease contributes to our understanding of underlying problems that affect movement influences decisions about clinical management.

Wahat may accompany aphasia

alexia, agraphia, or agnosia

What is divided attention?

allocating limited resources to multiple processes or tasks

describe svPPVA

also associated with FTD initial smptoms are those of aphaisa atrophy of the temporal lobe progressive loss of word meaning initially intact fluency and rep; rep of words not named or comprehended; intact phonological skills, motor skills, and orientation to time and space excessive and disinhibited speech visual agnosia and prosopagnosia as the right temporal gets involved progressively shorter sentences and phrases; eventual mutism behavior changes in the later stages especially when the atrophy spreads to the right temporal lobe.

Describe Primary Progressive Aphasia

aphasia without dementia isolated language disorder preserve other cognitive abilities Starts with one language functions early with naming difficulty

What is the theoretical approach to AOS?

approach to AOS claims that the processes that build the phonological representation of a message are intact but the phonetic-motoric level of production is disrupted refer to AOS as a deficit in sequencing the spatiotemporal aspects of movement at a prearticulatory level. a phonetic-motoric disorder that affects the translation of an intact phonological representation of a message into the learned kinematic parameters for an intended movement.

What is strengthening of the articulators appropriate for?

appropriate for spasticity/rigidity prolonged directional stretch can be applied to reducing tone in tongue, lips, and jaw Be sure that decreased strength is a part of the problem---- you see them drooling, they cant close, you know they have weakness.

-confabulation and excessive speech?

are characterized by excessive inference, too much attention to minor details, and saying too much with borders on confabulation

What is targeted for articulatory function?

articulatory imprecision

Describe the bells test

asked to circle only the bells printed on a page that also contains other objects

Describe the Ranchos Los amigos levels of cognitive function?

asses cognition and behavior at the levels of no response, generalized response, localized response, confused-agitated, confused-inappropriate, confused-appropriate, automatic-appropriate, and purposeful-appropriate.

Describe the Test of visual neglect

asses neglect by asking the patient to cross out short lines randomly printed on a page

Describe the behavioral inattention test (BIT)

assess neglect in such functional tasks as reading maps, menues, and newspapers and using a telephone

describe audiotry verbal agnosia?

associated with bilateral temporal lobe lesions that isolate wernicke's area and is characterized by impaired understanding of spoekn words, normal peripheral hearing, normal recongtion of nonverbal soudns, normal recogntion of printed words, and normal or near nomral verbal expression and reading.

How is coordinated movement most obvious with cerbellar damage?

associated with staggering or reeling gait compensated for by broad-based gait rocking motions, rotate or tilted head posture, hypotonia over nd undershooting of targets

describe nfvPPA?

associated with structural and metabolic changes limted to the left perisylvian language area pathology typical of pick's disease and alzheimer's may be evident earlies signs of anomia, word finding difficutlies, aos, reduced fluency, artic problems, agrammatism, impaired rep, slow rate and prosodic impairments memory and cognition relatively preserved until about 2 years postonset; daily living unaffected behavioral changes typical of bvFTD including apathy, disorganization, inappropriateness, and agression slow progress of the disease

describe lvPPA?

association with neruopathology of DAT and FTD damage to the left posterior superior temporal and middle temporal gyri and the inferior parietal lobule characterized by slow speech, word finding pauses, no agrammatism, speech motor control problems, telegraphic speech or prosodic deficienices only moderate naming difficulties in early stages severe difficulty repeating phrases and sentences; intact repetition of short single words in initial stages, impaired subsequently impaired sentence comprehension behavioral changes

What is awareness?

assumes arousal; from stupor to clear perception of surroundings

How would you assess Overall functional status?

at rehabilitation centers, a patient's functional independence is rated soon after admission and at discharge. Rating scales are used to assess activities of daily living. A) Functional Independence Measure (FIM-SUNY): a multidisciplinary scale intended to measure overall severity of disability consisting of 18 items in 4 motor categories and 2 cognitive categories. B) Rehabilitation Outcome Measure (ROM): contains separate 7-point scales for SLP, OT, and PT.

Describe Huntington's

autosomal dominant typical onset in fifth decade progressive and fatal usually loss of neurons from caudate, pallidum and cerebral cortex

Describe Reduce demands on episodic memory

avoid requests to retrieve experiences from memory and , yes/no response Stimulating spared stores such as procedural memory o Using external memory aids

Describe prosopanomia?

b. Different lighting and angles can interfere with face recognition c. parallel problems with objects d. the facial percept activates a stored recognition unit of someone's appearance e. misperception or a reduced buffer search speech that might affect performance on recognition tasks

What is a hemorragic stroke?

bleeding in the brain due to ruptured blood vessels

How do both extrapyramidal dysarthrias present?

both groups have rigidity and loss of normal postural reactions Basal ganglia indirectly influences motor activity- feeds back to the cortex which then sends out

Describe stage 2 of ALS?

both speaker and listener notice changes in speech

What does Bulbar mean?

brain stem.

Describe Broca's Aphasia

broadmann's areas 44 and 45 posterior inferior frontal gyrus MCA

What is another name for Flaccid dysarthria?

bulbarpalsy (affecting cranial nerves that come off the brain stem)

how are resonance disorders assessed?

by making clinical judgements of hypo and hypernasal speech and nasal emission through a mirror at the nares at prolongued /i/.

What questions do we ask about our goals?

can patient meet their nutritional/hydration needs PO, will there need to be alternate means nutrition

What is Pseudobulbar?

can resemble bulbarpalsy- it has some of the same characteristics but is not the origin or etiology at the brain stem but the upper motor system.

What is positive Romberg sign?

cannot stand with eyes closed

What is paralysis caused by?

caused by damage to descending pathways that terminate on alpha motor neurons

What is the neuropathology of AOS

caused by injury or damage to speech-motor programming areas in the dominant hemisphere, such as Broca's supplementary motor areas vascular lesions that cause stroke frontal lesions and sometimes parietal

Describe Transcortical Motor Aphasia?

caused by lesions in the anterior superior frontal lobe, below or above Broca's area ACA, and MCA usually rigid of upper extremities akinesia bradykinesia buccofacial apraxia right hemiparesis little interest in communcation

What can be the site of damage that causes flaccid dysarthria?

cell body, axon, or neuromuscular junction

Pragmatic deficits?

characterized by problems in conversational turn taking, topic maintenance, and maintaining eye contact as well as rambling, excessive speech with little communicative value, and impulsive speech

What is childhood-onset disease?

characterized by tics involving the face, neck, upper limbs and sometimes entire body

Define spastic dysarthria?

characterizes dysarthrias arising from (usually bilateral) damage to upper motor neurons (corticobulbar tract)

What is important about articulatory imprecision?

characterizes most dysarthria's use terms that provide more useful information determined by underlying neuropathology and severity

How is dysarthria characterized?

classified according to symptoms attributed to damage to specific parts of the nervous system

What is typological?

classify aphasia into types

What is the goal of the super-supraglottic swallow?

close entrance to the airway by the anterior tilt of the arytenoids to the epiglottis before and during the swallow

~Describe mild traumatic brain injury (MTBI)?

closed-head injury lost for less than 20 inutes; concusion. Coup injury~~-the brain injury at the point of impact (blow to the head) is called the coup injury; the injury at the opposite side of the impact caused by moving brain striking the skull is called the contrecoup injury

What are the levels of training?

cognitive reading from marked scripts reading/speaking without aid of respiratory markings Mark a passage where they should take a breath.

What is central dyslexia?

cognitive; disorders of the reading process, can be a component of aphasia.

Describe swallowing problems and CP?

common in children with CP and dysarthria (including saliva management and nutritional problems) b sucking and swallowing problems common in first year of life problems may occur at any stage of swallowing

How do you assess reading skills?

comprehension of silently or orally read material (matching single printed words to pictures, printed words to spoken words, crossing out words that do not belong in a list). verbal completion of printed sentences (reading the printed incomplete sentence (we wear hats on our...)

role of superior, middle, inferior constrictors

compress the pharynx, move bolus from oral cavity to UES within the pharyngeal phase

buccinator function

compresses lips and cheeks against teeth; draws corners of the mouth laterally. keeping bolus from collecting in lateral sulci

medial pterygoid function

counterpart of masseter

palatopharyngeus function

elevates lateral walls of pharynx, lowers soft palate

palatoglossus function

elevates posterior tongue and lowers velum

Describe the dependent variables of Tjaden and Wilding?

dB SPL, F1/F2 space, F2 trajectories (diphthongs), first moments for consonants

Texas Functional Living Scale?

daily iving activities, orientation, functional redin and writin , and memory

What is the cause of Paralysis?

damage to alpha motor neurons

What does the basal ganglia do?

dampens or modulates cortical output that would otherwise be in excess of that required to accomplish movement helps to maintain stable musculoskeletal environment in which discrete movements can occur excessive or insufficient damping of cortical output results in movement disorders

What are the respiration characteristics of hypokinesia?

decreased intensity and intensity range

What are teh causes of flaccid dysarthria?

degenerative diseases such as amyotrophic lateral sclerosis, motor neruon disease, progressive bulbar disease, multiple systems atrophy (MSA), myasthenia gravis, botulism, vascular diseases, brainstem strokes, infetions, demylinating diseases, trauma due to surgery.

What is the cause of PPAOS?

degenerative neural diseases such as Alzheimers, MS, primary progressive aphasia

what is the neuropatholgoy of FTD?

degenration of nerve cells in the left and right frontal lobes, temporal lobe, or both the lobes in the two hemispheres in the classsic (pick's disease) possible focal atrophy involving the anterior frontal and temporal lobes, and the orbital frontal lobe, and the medial temporal lobe the presence of pick bodies (dense intracellular formation in the neuronal cytoplasm) and the precence of pick cells (ballooned and inflated neurons) in the cortical layers absence of pick bodies and pick cells in some variants of FTD, but the presence of atrophied, gliosed, and swollen brain cells

What are the swallowing characteristics of cerebellar damage?

degree of dysphagia varies depending on involvement of oral musculature and whether predominant symptoms are due to upper or lower motor neurons aspiration more common with LMN than UMN damage dysphagia usually parallels or follows loss of speech

Define comprehensibility?

degree to which a listener understands an utterance produced by a speaker in a particular communication context

Define intelligibility?

degree to which the acoustic signal (i.e., utterance produced) is understood by the listener

What are the neurologic characteristics of huntington's?

dementia involuntary movements choreic movements limbs are hypotonic posture cannot be maintained

what are specific techniques used in intervention with aos

demonstration, modeling, shaping, phonetic placement, frequent cuing usesing rhythm, placemtn of articulators, modling, delayed immitation, contrastive stress, phonetic contrasts carrier phrases and singhing.

What does MS do?

demyelination causes sclerosis (scarring) of brain tissue (= plaques in white matter)

styloglossus function

elevates sides and posterior tongue

What is obtained from the AIDS?

designed to provide a clinician-judged technique for measuring intelligibility in a clinical setting provides objective measure of sentence and single word intelligibility during a reading or imitative speaking task

How do we assess those functions

detailed case history bedside evaluation Standardized testing repeatedly and directly observe the patient before administering standardized diagnostic tests to a patient may design client-specific activities to assess a patient's unique condition Common supplemental tests

what is the assessment of AOS?

detailed case history interview, detailed observation of speech production tape recording and transcribing taking note of dysfluencies evoke imitative production of speecsound, repetion of syllables, multple syllables (putuku), repeated, imitative progressivly longer words when modleing is provided, (encyclopedia, unequivocal), evoking repeated production of wrod and phrases, sentences, couting, picture descriptions, oral reading, administering a comple diadochokinetic test to asses oral and nonverbal movment, limb movments, standardized assessments

Describe assessment?

determining what is important and what it not involves the interpretation of descriptive information and estimating the significance or value of that information for management and remediation

Where does the tongue deviate for flaccid dysarthrias?

deviates to the right, right is atrophied- mean that the right hypoglossal is affected

Describe stage 1 of ALS?

diagnosis has been made, but often speakers do not yet exhibit speech symptoms primarily a spinal cord presentation at this point

What are important considerations for treating respiratory function?

different patterns of respiratory impairment exist for dysarthrias with different etiologies difficulties relate to loudness or loudness variation as well as breath group duration

Describe assessment of Pragmatic language problems?

difficulty in initiating conversation, turn taking, selecting appropriate topics for conversation, maintaining topic and cohesion, rambling, and understanding the meaning of facial expressions and gestures are best assessed during interview and conversation with the patient

What are they swallowing characteristics of spastic dysarthria?

difficulty with oral transit and aspiration even with unilateral damage

What are the neurologic characteristics of dyskinetic syndromes?

disorders of posture and involuntary movement may not be apparent until 1 or 2 years of age, with initial hypotonia and gradual onset of involvement of involuntary athetoid and choreic movements many primitive postural reflexes retained, especially tonic neck reflex feeding and walking may be very difficult dysarthria and dysphagia are common deafness most likely to occur in this population (but not very common)

What are the characteristics of Conduction Aphasia

disproportionate impariement of repeititon varialbe speech fluency less fluent than wernicke's paraphasic speech word finding problems empty speech efforts to correct areas good syntax, prosody, and articulation severe to mild naming problems near-normal auditory comprehension better at pointing to a named stimulus than confrontation naming highly variable reading problems writing problems buccofacial apraxia Verbal expression deteriorates on long phrases Impaired connection between structurally intact areas: disconnection syndrome. - A syntactic comprehension deficit may be present.

What are the two components of ataxia?

disruption of coordinated movement and decomposition of movement

What is the AIDS useful for?

distinguishing mild from normal and for controlling judge familiarity

Give an example of typological?

disturbance of any or all of the skills, associations, and habits of spoken or written language, produced by injury to certain brain areas that are speciallized for these functions.

what are the language problems associated with FTD?

dominant language problems with somewhat better preserved memory and orientation, contrasted with patients who have DAT anomia progressive loss of vocab and consequent paraphasia and circumlocution difficulty defining common words and problems reciting category-specific words limited sponateous speech, echolalia, and nonfluent speech impaired comprehension of speech and printed material.

Describe drug treatment for aphasia?

dopamine agnostics, piracetam amphetamines, and donepezi at both the acute and chroic stage but results have been unimpressive

What is Bell palsy's affect on speech?

drooling, inability to close mouth- almost not a dysarthria, limited affect on speech

What does Athetosis mean?

dystonia

What is slow hyperkinesia?

dystonia

What is the treatment of apraxia?

easily produced words, concerned with speech movements, practice with a variety of sound and sound combinations, positive reinforcement for correct responses and corrective feedback, articulatory accuracy, slower rate, systemic practice, gradual increasing rate and prosody. modeling, shaping, phonetic placement, frequent cuing, use of rhythm, immediate positive or corrective feedback, fading, pushing on abdomen to achieve vocal fold closure, pacing board or metronome to slow speech rate and improve articulatory proficiency. empasis on total communication, slef monitoring skills and self correction.

When are the effects on speech seen for myoclonus?

effects on speech may only be evident on sustained phonation

What are group treatments for aphasia?

efficient, follows a period of individual treatment. total communication via many means, conversation, narrative, problem solving

What is important for Phrase length?

either don't have breath support (like als) but usally have vocal fold leaking. Reflexes shouldn't be preasent in the adults.- as we mature, primative reflexs go away. See it in adults- the nervous system has released the inhibition on the

mylohyoid function

elevates and depresses jaw, also laryngeal elevation

digastric - posterior belly - function

elevates hyoid/larynx

stylopharyngeus function

elevates larynx, elevates and dilates pharynx

Descirbe the Communication Abilities in Daily Living?

emphasizes communication in everyday situations. Such as reading, writing, estimation of time, use of verbal and nonverbal contexts in communication, role playing, social conventions, nonverbal symbolic communication, humor, absurdity, and metaphors as rated

What are the neurologic characteristics of ataxic syndromes?

errors in rate, range, force and direction of movement overshoot or undershoot spatial targets wide-based ataxic gait hypotonia

What is paralexia?

errors in the spoken reading of words

Describe the Functional Lingustic Communication Inventory?

esp important for middle to late stages of DAT

What is important about Patient motivation?

ethical consideration and our role when they refuse our recommendations.

What are the etiologies of ataxic dysarthria?

etiologies may include stroke, tumor (metastatic or primary), degenerative diseases, trauma, alcoholic degeneration, multiple sclerosis, bilateral or generalized cerebellar lesions, degeneartive (friedreich's ataxia and olivopontocerebellar atrophy and late onset autosomal dominant and idiopathic sporadic forms), cerebellar vascular lesions, demelinating diseases.

What is the purpose of functional assessments?

evaluate daily communication in everyday setting, less biased in evaluating clients with cultural and linguistic backgrounds, require extensive and systematic observation

How do you treat aphonia?

evaluate reflexive phonation and develop voluntary phonation.

Describe the Porch Index of Communicative Ability

evaluates audiotry comprehension, reading, oral expressive langauge, pantomime, visual matching, writing, adn copying. intensive training to administer and score (PICA)

Describe the Minnesota Test for Differential Diagnosis of Aphasia

evaluates five areas of performance: auditory disturbances, visual and reading disturbance, speech and language disturbances, visuomotor and writing, numerical and arithmetic, use subtests not normative data

Describe the Western Aphasia Battery

evaluates speech content, fluency, and auditory comprehension, repetition, naming, reading, writing, calculation, drawing, nonverbal thinking, and block design. can try to classify aphasia into types.

Describe the Neurosensory Center Comprehensive Examination for Aphasia

evaluates such langauge functions as comprehension, production, reading, writing, word fluency, digit and sentence repetition, visual object naming, sentnece construction, and articualation. also visual and tactile functions.

how are articulation disorders assesed?

evaluating consonant productions, duration of speech sounds, phoneme repetition, irregular breakdowns in articulation, precision of vowel production, phoneme distortions, and adequacy of pressure consonantal production.

how are prosodic disorders assessed?

evaluating the rate o speech, phrase lengths in selected portions of speech, stress patterns in speech, pauses, and the presence of short rushes.

Describe th multilingual aphasia Examination?

evluates aphasia in English, French, German, Italian, and Spanish

what are the respiratory, articulatory, prosodic, phonatory, speech, adn resonance disorders of ataxia?

exaggerated and paradoxial movement during speech production imprecise production of consonants irregular articulatory breakdowns and distortion of vowels excessive and even stress, prolonged phonemes and intervals between words or syllables and slow rate of speech monopitch, monoloudness, and harsh impression of druken speech intermittent hyponasality in some individuals

What are the prosody characteristics of cerebellar dysarthria?

excess and equal stress (prominent DAB feature) prolongation of intervals speech may have an explosive or scanning quality

What are the respiration characteristics of slow hyperkinesia?

excess loudness variations (DAB)

What is the expectation with generalization?

expectation is that generalization should occur to novel behaviors that are related in some way to the trained behavior, not to just any novel behavior

How do we assess gestures and pantomime?

expression through gestures and pantomime comprehension of gestures and pantomime

buccinator

facial

digastric - posterior belly

facial

orbicularis oris

facial

Give another type of test to study memory?

few seconds is placed between a subspan series of digits and the recall test. A subject is asked to count backwards during the interval in order to minimize the rehearsal of the list. - One version of this type of test is the Portland Digit Recognition Test, which has been used to determine if financial incentives influence the measurement of cognitive deficit in mildly head injured people. - The no-compensation group was superior, possibly indicating that the compensation group was exaggerating or malingering.

What are the 7 sections of the frenchay?

first 6 sections assess function of reflexes, respiration and various articulators (for speech and nonspeech tasks) last section assesses intelligibility typical profiles available for various types of dysarthria

What is L dopa-induced dyskinesia?

first synthetic dopamine- crossed the blood brain barrier, sued to treat parkinson's and they when from hypokinetic to hyperkinetic.

What is the first step of intervention?

first thing you do is consider the compensatory treatments

verticalis function

flattens tongue body, fibers run vertically

tensor veli palatini muscle

flattens, tenses, slightly lowers the palate. not involved in chewing. most important affect: opens auditory tube.

Describe Anomic Aphasia

fluent controversial different lesions cause it Site of lesion is elusive angular gyrus, tempora gyrus, juncture of teh temporoparietal lobes syndrome most language forms are relativley unimpaired difficulty with divided attention

What are the characterizations of subcortical aphasia in the basal ganglia

fluent speech intact repetition normal auditory comprehension articulation problems word finding problems semantic paraphasia relatively preserved writing skills limb apraxia possilby

Describe Transcortical Sensory

fluent, lesions in the temporoparietal region posterior portion of the middle temporal gyrus, brocas, wernickes and acruate fasciculus may be spared MCA hemiparesis may disappear neglect one side of the body]

Describe Wernicke's aphasia?

fluent, lesions in wernickes, posterior portion of the superior temporal gyrus confused less frustrated paranoid, homicidal, suicidal, depressed free from obvious neurological symptoms

What are the three classification of aphasia

fluent, nonfluent, subcortical

What is selective attention?

focus; resistance to distraction; managing limited resources by selection

What happens after fasciculations?

followed by absence of firing and shrinking of muscle (atrophy)

What are the communicative disorders associated with dysathria?

forced inspirations or expirations that interrupt speech, audible or breathy inspiration, and grunting at the end of expiration Phonatory, articulation, prosodic, resonance

Define Anterograde amnesia?

forgetting memories acquired after the injury (i.e., recent memory) Information acquired after the injury, investigations have consisted of new learning procedures. Person has difficult learning because forget memories after injury. Thus, this type of memory impairment is the most problematic for rehabilitation

Define Retrograde amnesia?

forgetting memories acquired before the injury (i.e., remote memory) i. Severity of retrograde amnesia increases as the memory gap extends further into the past.

What are the resonance characteristics fo spastic dysarthria?

frequent hypernasality (without nasal emission)

What is the treatment of writing skills? (functional)

functional skills such as functional words (name, family member), functional lists (grocery), short notes, reminders, filling out forms, writing letters.

What do you assess for Reflexes?

gag jaw jerk sucking snout

What does Flaccid dysarthria involve?

gamma motor neurons

what are the language problems associated with DAT?

general word finding problems naming problems, verbal and literal paraphasias and circumlocution problems comprehending abstract meanings impaired picture description difficulty generating a list of words that begin with a specific letter echolalia, palilalia, and logoclonia empty speech, jargon, and hyperfluency incoherent, slurred, and rapid speech pragmatic language problems, including inattention to social conventions; difficulty initiation and maintaining conversation, decreased speech output, inappropriate speech reading and writing problems in the final stages, no meaningful speech, mutism, and complete disorientation to time, place, people, and self.

posterior 1/3 of tongue - sensation and taste

glossopharyngeal nerve

palatoglossus

glossopharyngeal, vagus, and accessory

How do you assess writing skills?

graphomotor skills (letter formation) general writing skills automatic writing confrontation writing (write the names of these pictures) writing to dictation narrative writing (wrtie a story about the picture) premorbid writing samples for comparison

What is assessment for arousal?

gross motor response to sensory stimulation

what is frontotemporal demtia?

group of heterogeneous diseases that include a behavioral varient of FTD and primary progressive aphasia

What are the phonation characteristics of slow hyperkinesia?

harsh or strained/strangled quality voice stoppages decreased pitch variability tremor

What are the phonation characteristics of spastic dysarthria?

harsh, strained and strangled quality may be audible grunts low fundamental frequency

What are the phonation characteristics in Huntington's?

harsh, strained/strangled voice quality (DAB) excess loudness variation (DAB) decreased F0 (DAB) voice stoppages and pitch breaks (DAB)

What is Sound Production Treatment?

has an emphasis on teaching articulation of words with minimal contrast (shock-sock)

What is the Functional independence measure?

has become a common measure of functional outcome in trauma-related rehabilitation programs as well as stroke-related programs. When administered 6 day after post onset, FIM is a good at predicting discharge to home, a rehabilitation center, or a nursing home. FIM is also predictive of burden of care at home, measured by the minutes of assistance per day provided by a caregiver.

Describe the instrumentation for McHenry 2003?

head-mounted strain gauge tranducers measured superior-inferior movements of lower lip and jaw

How do you assess auditory comprehension of spoken language?

hearing evaluation visual evaluation appropriateness of nonverbal response to verbal commands of clinician comprehension of natural commands given without gestures (move your chair closer, close your eyes) Comprehension of multistep commands (pick up the pencil and ocmb and place them in the box)

~Describe treatment Pragmatic impairments

helpful techniques include video taped conversations that show appropriate and inappropriate pragmatic behaviors to draw the patients ~Describe treatment attention to such behaviors. The clinician may also give frequent reminders to maintain eye contact and continue talking on the same topic

~Describe treatment Impaired inference

helpful treatment techniques include the use of pictures that depict situations that require inference and reinforcement for correct inferences

What is important about Caregiver support?

helping them and buying the thickened liquid.

Describe The Burden of Stroke Scale

helps access limitations in mobility, self-care, sleep, cognition, and social relations, along with psychological distress associated with stroke

Describe the Galveston orientation and amnesia test?

helps asses amnesia, orientation, and memory

Describe the coma recovery scale revised CRS-R

helps asses auditory, visual, motor, and oral communication and arousal parameters.

Describe the disability rating scale?

helps asses changes in patients with head injury; assess eye opening, verbal responses, motor Reponses, feeding, toileting, and so forth

Describe the Examining for Aphasia-4th Ed

helps asses language comprehnsion, production, agnosia, volitional movments, reading, writing, and storytelling.

Describe the aphasia Diagnostic Profiles?

helps asses overall seveity of aphasia, comprehension, word retrieal, repetition, and alternativecommmunication.helps classify aphasia

Describe the Scales of Cognitive Ability for TBI (SCATBI)?

helps asses perception, orientation, organization, recall, and reasoning

Describe the he right hemisphere language battery Second edition (RHLB-2)

helps assess comprehension of spoken and printed metaphors, inferred meanings, appreciation of humor, and discourse.

Describe Functional Independence Measure

helps assess overall severity fo disability; it is integrated into medicare and medicaid's reimbursment for clinical services.

The super supraglottic swallow

helps close the airway before and during swallow -procedure also promotes false vocal fold closure -the patient is asked to inhale and hold the breath tightly by bearing down an swallow while holding the breath And bearing down

Describe the mini inventory of right brain injury- Second edition (MIRBI-2)

helps evaluate skills such as visual scanning, integrity of gnosis (finger identification, tactile perception, two-pt discrimination,) integrity of body image, reading and writing, drawing, and affective and abstract language.

what are the characteristics of subcortical aphasia caused by lesions in the left thalamus?

hemiplegia, hemisensory loss, right-visual field problems initial mutism which may improve to paraphasic speech sever naming problems good auditory comp of simple, poor of complex good repetition impaired reading and writing

Describe feedback frequency?

high vs. low; Evidence that reduced frequency feedback benefits motor learning

What are the articulation characteristics of slow hyperkinesia?

highly variable/irregular articulatory breakdown (DAB) imprecise consonants (DAB) distorted vowels (DAB) place and voicing errors predominate prolonged phonemes/intervals (DAB)

What are the phonation characteristics of hypokinesia?

hoarseness, breathiness monotony of pitch

What is important about Visual status?

how much they take to eat, knowing what in front of them is food/not. Visual field cut- perception of depths and reduced acuity. Ability to wear glasses.

What is Resonatory incompetence?

hypernasality due to inability to elevate velum

what are the resonance disorders?

hypernasality, hyponasality, and nasal emision

CN XII

hypoglossal

geniohyoid - hypoglossal

hypoglossal

hyoglossus

hypoglossal

inferior longitudinal

hypoglossal

styloglossus

hypoglossal

superior longitudinal

hypoglossal

transversus

hypoglossal

verticalis

hypoglossal

genioglossus - hypoglossus

hypoglossus

Describe Communication boards as a compensatory behavior

i. Communication boards can consist of letters, words or pictures. They are useful for individualized content that is hard to gesture about. For example, train a patient to use a Language Pocket Book, which consists of word lists and pictures organized by category or situation. Pointing behavior is a valuable communicative tool that can be used in real-life settings. The patient can be taught to point to pictures or words in the communication book in order to express himself. ii. Additionally, menus are communication boards. Some menus have pictures of the food and a patient can point to an item. Another example, a person can tear out pages as a shopping list and use them to ask about the location of an item.

What are the Steps for scripted dialogues?

i. First the patient and clinician practice by following the script ii. The patient then may practice with another listener, often a family member. The clinician reminds the patient of strategies and sometimes coaches the listener. This activity is videotaped and the participants get together to view and discuss it iii. The entire procedure may be repeated with a stranger

Describe Gesturing and drawing as a compensatory behavior?

i. Many aphasic persons retain a capacity for gesture and drawing ii. Pantomime gesturing may be taught using Visual Action Therapy (so someone who cannot speak verbally, can express what they what through pantomime). The program begins with matching tasks for perception and recognition of objects and proceeds to gesturing of function with the object in hand and then without the object. It should be intelligible. Try drawing after traditional language treatment has failed Drawing may facilitate spoken word finding

What is Visuopatial Expression?

i. Symptoms seen in absence of limb apraxia or hemiparesis, include: i. Constructional Apraxia: 1. On PICA, had lower scores in shape copying 2. Neglect left side when drawing common objects: a clock, house, flower ii. Spatial relationships and proportions are usually not preserved in RHD drawings 1. Neglect the left side of a picture, poor spatial relationship j. In a study of drawing objects from memory, RHDs have lower recognizability scores than LHDs k. In drawing a person, RHDs are disorganized and embellish with extraneous detail l. In general, parietal RHDs draw details inchoherently, whereas parietal LHDs omit details in a coherent structure

What are the four principles and essential procedures of PACE?

i. The clinician and patient exchange new information: instead of having a picture of an object or event (called the message) is simultaneous view of the clinician and patient. A stack of message stimuli is placed face down to keep messages from the view of a message receiver. A client selects a card and attempts to convey the message on the card. A modification is to have the client choose the message from a screen of options ii. The clinician and patient participate equally as senders and receivers of messages: Involves turn-taking; the clinician and client simply alternate in drawing a card and sending messages iii. The patient has a free choice as to the communicative modes used to convey a message: We do not tell the client to perform in a particular way iv. The clinician's feedback as a receiver as a receiver is based on the patient's success in conveying the message: Our feedback should let the client know if he or she got the idea across b. Found to improve communicative abilities but not language skills

Define Auditory agnosia?

impaired ability to recognize sounds despite adequate hearing; a person has normal hearing, but has impaired recognition auditory stimuli (e.g., a person hears a common sound, such as a hissing teapot, but does not turn off the teapot because of failure to recognize what the sound is) associated bilateral damage to the auditory association area

What are the prosodic characteristics of MS?

impaired emphasis (DAB term) may be excess and equal stress

What are the general symptoms of AOS?

impaired oral sensation sometimes with broaca's coexisting. Nonverbal oral apraxia NVOA may be in some patients with right hemisparsisi and sensory deficits.

Define Apraxia of Speech?

impaired programming of movement for the purpose of speaking without neuromuscular deficit; most likely no difficulty chewing or swallowing. articulatory-phonological disorder unimpiared reflex and auotmatic effects

Define Prosopanomia?

impairment in naming familiar faces a perceptual disorder that appears as a deficit for recognizing unfamiliar faces

Define Prosopagnosia?

impairment in recognizing familiar faces (bilateral occipito—temporal lesions)

Describe agnosia?

impairment in understanding the meaning of certain stimuli even though there is no peripheral sensory impairment- can see, feel, and hear stimuli but not understand their meaning.

Describe Since RHD patients are able to access non-literal meaning automatically/

impairment lie may exist in controlled operations for choosing pictures or giving definitionsWhen given a semantic priming task, in which a lexical decision target (e.g., sharp) was preceded by a metaphoric prime (e.g., smart), literal prime (e.g., dull) or unrelated prime (e.g., warm), both related primes facilitated target recognition for RHDs and LHDs

Define Phonoagnosia?

impairment of discrimination or recognition of voices (R parietal lobe)

Define Constructional apraxia?

impairment of visuospatial motor functions, e.g. building objects or drawing pictures

what is Constructional Apraxia?

impairments of visuospatial motor functions, e.g., drawing or building 5. Worse in shape copying (draw a clock, house, flower) 6. RHD have lower recognizability scores than LHD 7. Neglect the left side of a picture, poor spatial relationship 8. Disorganized and embellish with extraneous detail, draw details incoherently 9. Spatial relationships and proportions are usually not preserved in RHD pts drawings. 10. ASL: perfect production, but difficulty with syntax comprehension 11. Able to do something but, difficulty doing sequence and lined up to do things.

Describe the 8 step continuum?

importance of intensive and extensive drill work on meaningful and useful communication importance of self-correction importance of selecting and ordering stimuli on the basis of the pattern of phonetic breakdown integral stimulation is a fundamental component in early steps of treatment, with cues gradually faded stimulus prompts are maximal initially and gradually faded, with response requirements gradually increased stimuli may be at the syllable, word, phrase or sentence level

What are the articulation characteristics of hypokinesia?

imprecise

What are the articulation characteristics of spastic dysarthria?

imprecise consonant articulation slow can be unintelligible

What are the articulation characteristics of cerebellar damage?

imprecise consonant articulation due to reduced movements as well as poor velopharyngeal closure distorted vowels slow unintelligible in later stages

What are the articulation symptoms of flaccid dysarthria?

imprecise consonant production may have inadequate intraoral pressure speech may be unintelligible depending on degree of involvement

What are the articulation characteristics of cerebellar dysarthria?

imprecise consonant production/irregular articulatory breakdowns (DAB) vowel distortion difficulty articulating sounds that require nearly continuous movement for their perception gross features of speech coordination may be preserved in the presence of timing errors = distortion

What are the articulation disorders?

imprecise production of consonants, prolongation and repetition of phonemes, irregular breakdowns in articulation, distortion of vowels, and weak production of pressure consonant

Describe physical exercises for aphasia?

improve fitness, balanc,e and strength

What was the effects of rate and loudness on intelligibility?

improved intelligibility for PD group in the loud condition speakers with MS were more intelligible in habitual condition. these results may be influenced by the fact that intelligibility was only mild-moderately impaired at the outset (although the PD group was less intelligible than the MS group).

What is fundamental cerebellar deficit?

in grading the development of muscle force

Define Ideomotor apraxia?

inability to carry out a motor command, for example, "act as if you are brushing your teeth" or "salute"

Define Ideational apraxia?

inability to create a plan for or idea of a specific movement, for example, "pick up this pen and write your name"

What is Ptosis?

inability to elevate eye- 3rd cranial nerv

What is Dysmetria?

inability to gauge distance, speed and power of movement may be overshoot or undershoot

What is dysdiadochokinesia?

inability to perform rapid alternating movement of muscles questionable diagnostic usefulness

Define Prosopagnosia?

inability to recognize familiar faces

Define Limb apraxia?

inability to sequence the movements of the arms, legs, hands, or feet during a voluntary action; cannot be attributed to paralysis.

What are the speech characteristics of dyskinetic syndromes?

inappropriate silences prolonged intervals and speech sounds excessive loudness variation voice stoppage may be velopharyngeal incompetence

Client specific measures

include language samples, narratives, discourse, and the analysis of these observations; the clinician may assess visual perceptual deficits by asking the client to draw simple pictures such as the face of a clock or the human face

Describe Areas of language that may show agrammatism

include lexicon, grammatical morphology and syntactic structure.

-Prosodic deficits?

include monotone, impaired stress patterns, reduced speech rate, lack of affect, and difficulty understanding prosodic meaning of other people speech

Describe the RIC Evaluation of Communication Problems in Right Hemisphere Dysfunction (RICE-3)

includes five subtest to evaluate cognitive and communicative deficits associated with right-hemisphere brain damage as well as nonverbal communication skills. In addition to an interview schedule and observation of an interaction

What are uncontrolled vocalizations?

includes grunting, coughing, barking, hissing, sniffing stuttering-like repetitions and echolalia coprolalia (involuntary swearing)

What is the treatment for naming skills?

incomplete sentences (you write with a ..) phonetic cues, syllabic, silent phonetic (articulate the phoneme), personalized verbal cues (he works on your Toyota), functional description of objects, description as stimulus for naming (tell me what you do with this and then say its name), demonstrate function (show me how to use it and tell me its name),printed pictures, spelling as stimulus (spell it first then say it or write it), sound as simulus (it makes a woof woof sound), rhyme as a stimulus (it rhymes with a..), synonyms,

Describe comprehensibility?

incorporates signal-independent information (e.g., syntax, semantics, and physical context)

What are the behavioral managements for respiratory function?

increase Ps levels initiate phonation at appropriate lung volume levels or at appropriate times in respiratory cycle

What is the goal for improving breathiness?

increase adduction

What is the goal for improving strain/strangled?

increase airflow (decrease adduction) increase F0

What is the parallel development of movements?

increase in the number and variety of oral movements and positions expansion of simple movements with smooth integration of 2 or more earlier nonreflexive movement patterns separation or differentiation of movement of 2 or more components of the system

What can be varied?

increase intraoral pressure (Po) plus burst intensity for voiceless stops alter vowel duration to signal voicing of final stops

What is the goal of the laryngeal elevation exercise (falsetto exercise?

increase laryngeal elevation and UES opening

What is the purpose of Pushing exercises?

increase thoracic pressure- lifting, etc. Have to close vf

What is the goal of lip exercises?

increased lip strength and ROM

describe level 2 of MIT?

increased utterance length (4 words) addition of alveolar and sibilants more complex morphology

What does feeding development involve in stage III?

increased variability in the combination of lip, tongue and jaw movements with different types of foods and different feeding needs increased separation of lip from jaw movements development of jaw stability in sucking and swallowing (contributes to increased independence of tongue from jaw movements)

What is the incidence of parkinsons?

increases sharply after age 64 males = females Damage to the basil ganglia---two types, hypo and hyperkinetic. Hypo and hyper relate to the paucity of movement versus too much movement; in both have unwanted movement Fail to inhibit the globis pallidus----- inhibitory function is damage, disinhibition of movement, such as a resting tremor.

What are the communcation deficits of AOS?

independent problem of auditory processing skills general awareness of speech problems slow or delayed initiation of speech may use compensatory strategies to reduce rate programming problems and observable speech production error

Describe the subjects of Tjaden and Wilding?

individuals with MS, PD and normal control

Describe stage 1 of oral motor development?

infant possesses a pool of reflexes, or automatisms, that subserve survival basic component of swallowing at this stage is rhythmicity vocal output is limited to crying, vegetative noises and cooing (early vowel-like productions)

inner layer of esophagus muscle

inner circular layer

What is apperceptive visual agnosia?

insufficient mental representation of a stimulus, perceptual difficulty, usually due to RH damage. (maybe have left neglect: will not see the left side of cup; may not know if it is a cup or other kind of container); those with apperceptive agnosia are unable to copy images.

Define Apperceptive visual agnosia?

insufficient percept of representation of a stimulus, perceptual difficulty, usually due to right hemisphere damage. Associative visual agnosia?+ failure to relate a good percept to a representation of the object in memory, recognition problem w/no perceptual deficit; failure to name but can match and copy.

what are the stages of late DAT?

intensified early-stage symtpoms severe problems recalling remote and recent events intensified viusopatial problems widespread intellectual deterioration hyperactivity, restlessness, agitation, meaningless handling of objects problems with arithmetic calculations profound disorientation to place, time, and person problems with self-care difficulty managing daily routines lack of affect, tact, and judgment loss o intitiative; indifference agressive or disruptive behaviors inappropriate humor and laughter seizures, myoclonc jerks, incontinance, and physical detoriation.

What effect does this have?

interferes with conduction of neural impulses affects white matter of hemispheres, brain stem, cerebellum, spinal cord, and optic pathways Can spontaneously improve and then symptoms can return Improvement, can get a little worse. Some cases wont affect speech One symptom is double vission

What is Phonatory-prosodic insufficiency?

intonation Lower motor damage can be to the axon, lower motor body, or the synapse. The neurotransmitter is released and picked up by the muscle. If there is an issue with the release or the pick up of the neurotransmitter, there will be a dysarthria. Myosinus gravis- that is an issue in the neuromotor juncture.

Describe two types of Hemmorrhage

intracerebral (within the brain) and extracerebral (within the meninges)

Describ the intracerebral hemorrhage?

invades deep regions of the thalamus, internal capsule and lenticular nuclei or basal ganglia

-impair discourse and narrative skills?

involve confusion between significant and irrelevant or trivial pieces of information in a picture description or conversational speech, , making picture inferences during discourse, and unelaborated narratives

describe Pallidotomy?

involves placing a lesion in the globus pallidus to abolish tremor, akinesia and postural instability Effect on speech is unpredictable

describe digital devices

ipads, provide audio and video feedback of a client's performance

What is bradykinesia?

is characterized by slowness of movement seen in Parkinson's disease and other disorders of the basal ganglia. The term describes a slowness in the execution of movement

What is knowledge of results?

is information about movement outcome (e.g., "You missed the target.")

What is description?

is the characterization of the features of a disorder

What is agrammatism

is the omission of grammatical morphemes in speech including function words and inflectional endings. limited to content words (nouns and verbs) omit function words such as articles, conjunctions, auxiliary verbs (e.g., is, are, was, were), copulas, prepositions, and inflections (e.g., plural and possessive forms, past tense ed).

What is assessment?

is the process by which decisions about intervention are made

What is the primary influence of the BG control circuit?

is through its connections with the sensorimotor areas of the cerebral cortex.

What is the philosophy of behavior modification?

is to change behavior, the causes of which are irrelevant. Operant conditioning has been used somewhat in the past; based on learning theory

What types of stroke are there

ischemic and hemorrhagic

Why is task complexity a reason for lack of treatment generalization?

lack of a sufficient number of exemplars of a particular behavior working from less to more complex behaviors (i.e., the traditional hierarchy)

Describe agraphia?

loss or impairment of normally acquired writing skills due to lesions in teh foot of the medial frontal gyrus of the brian (referred to as Exner's writing area).

inferior longitudinal function

lowers and retracts tongue tip

How do you stabilize the respiratory pattern?

lung volume level chest wall shape eliminating abnormal respiratory behaviors

What are the social approaches to treating aphasia?

main goal is natural interaction, conversation, functional communciation, and enhancemnt of life participation. compensatory strategies

What is Stidor?

make a sound during inhale- cannot abduct the vocal folds because they cannot get the vocal folds-

Describe the Glasgow coma scale?

make an initial assessment of eye opening motor response and verbal response

Describe Discourse Comprehension in RHD?

make more errors with inferences than with factual statements chose the right punch line 60% of the time (compared to normals at 81%) o Difficulty revising initial interpretation of a statement (as in sarcasm) o Generally, pts recall main ideas better then details & explicit info better than implicit info

How do you assess functional communcation skills?

make simple requests (tell them to write and wait for them to ask for pencil) telephone conversation participation in conversation facial recognition ability to keep appointments understanding of environmental signs ability to write own name ability to make a grocery list

what are biofeedback tools used for resonance therapy?

manometer or air pressure transducer.

What is visuospatial attention?

many patients present with a disorder of selective or focused attention (hemi—inattention) (not a disorder of eye movement but a cognitive impairment),Left neglect

What are the late neurological characteristics of MS?

marked gait difficulties dysarthria significant weakness and visual disturbances

What is akinesia/hypokinesia/

marked poverty of spontaneous movements loss of normal associated movements (e.g. arm swinging while walking) slowness in initiation and execution of all voluntary movement

what are the stats on dementia?

may be as high as 25% in people age 65+; after age of 65, prevalence doubles every 5 years

What are the resonance characteristics in huntington's?

may be hypernasality

What are the resonance characteristics of hypokinesia?

may be hypernasality with brain stem involvement

What is the oral musculature in Huntington's?

may be involuntary movements or inability to sustain movements

Describe discourse in normal aging

may be more verbose than earlier may assume "shared knowledge" fewer proper nouns used in discourse broader & freer word associations/ topic maintenance emotional - evaluative - personal responses

What are the phonation characteristics of cerebellar dysarthria?

may be normal or show excessive loudness and/or pitch variation may be a coarse voice tremor

Describe Abnormal postures, tone and movement?

may be reflected in oral and respiratory-phonatory systems patterns become biased in the direction of the abnormality because proximal stability may not develop, distal stability is impaired abnormal patterns become blocks to further development and/or evolve into habitual patterns

What does myoclonus cause?

may cause small jerks or violent movements

How are voicing distinctions improved?

may compensate for timing problem by varying other dimensions

What are the resonance characteristics of MS?

may evidence hypernasality

What are the swallowing symptoms of flaccid dysarthria?

may have significant problems

What are the two types of mixed dysarthrias?

may result in spastic-flaccid or spastic-ataxic forms of dysarthria ALS_ affects upper and lower motor neurons- spastic- flaccid. Ms- will have damage in both upper and cerebellum- may have spasticity and ataxi

What are the phonation characteristics of ALS?

may show symptoms similar to pseudobulbar plasy and may show predominately bulbar signs

Describe intelligibility?

measure of the adequacy of the acoustic signal product of (1) the amount of impairment and (2) the compensatory strategies employed signal-independent (i.e., context) information is held constant used as an indicator of overall severity

What are the two approaches to management of AOS?

medical intervention and behavioral management

What are the experimental approaches to treating aphasia?

non invasive brain stimulation, drug treatment, physical exercises, digital devices

Describe the conclusions of McHenry 2003?

most subjects improved with decreased rate however, individuals with different types of dysarthria manifest differing effects of temporal vs. spatial variability decreasing rate may be beneficial for those with PD the spatial domain may be more variable in ataxia

Describe the behavioral methods for VP function?

most successful with speakers with mild VP dysfunction who can at least sometimes achieve adequate closure question about training nonspeech functions

What is integral stimulation?

motor learning approach focus is on demonstrated area of motor deficit hierarchy of stages gross motor control over oral structures production of maximal articulatory contrasts combining sounds into patterns CV, VC and/or CVC units increasing length (and presumably memory for) of articulatory patterns

What are the general rules of the 8 step continuum?

move through steps at a pace that keeps patient successful repetitive drill will be necessary to help patient 'relearn' motor sequences to produce volitional speech use functional, useful words in therapy as soon as possible teach compensatory strategies to facilitate speech (e.g., vowel prolongation, slowing rate, and pausing as needed) •

What do you asses for velar function?

movement during production of /a/ symmetry

lateral pterygoid function

moves mandible laterally

levator veli palatini function

moves soft palate superiorly and posteriorly

genioglossus function

moves tongue anteriorly; anterior fibers pull tongue tip down and back

What happens with muscle contractions with fundamental cerebellar damage?

muscle contractions have uniformly long durations, yielding slow velocities to all movements and uniform durations to syllables

What is Atrophy?

muscle fibers thin because they are not innervated

What does pathophysiology and neuromuscular problems include?

muscle weakness, spasticity, incoordination, rigidity reduced or variable range and speed of movement, involuntary movements, reduced strength of movement, unsteady or inaccurate movement and abnormal tone (increased, decreased, or variable)

Is VP function targeted individually?

must be considered in relation to other aspects of speech production VP incompetence can exaggerate the impairment in other speech components and may bring about maladaptive compensatory adjustments in other aspects of speech.

transversus function

narrows tongue body, elevates side of tongue, fibers run side to side

Define Primacy/ Rule of Ribot?

native/first language should be less impaired and will be recovered first

Describe stage 4 of ALS?

natural speech is no longer a functional means of communication in all situations moderate to severe dysarthria

What is stage 4 of ALS characterized by?

natural speech supplemented

What are the speech characteristics of slow hyperkinesia?

nearly all aspects of speech may be disturbed direction and rhythm of movement are altered slow rate

What are the foundational concepts of treating aphasia?

need for aphsia therapy that improves communciation skills in everyday life and overall quality of life.

How do you interpret assessment measures?

need to understand what is accounting for the problem and what the appropriate treatment strategies might be Why does this person sound this way? What about the speech mechanism is contributing to/responsible for the dysarthria?" For example, it is not particularly illuminating to say that a speaker sounds a certain way because he/she has Parkinson's disease. ALS- wont do strengthening- will get fatigued; but for others you may do strengthening exercises. Why does this person sound this way- speech is rapid, volume is low, etc.

What is left neglect?

neglect of one-half of space cause by damage in the parietotemporal region, common on left in RHD; they can see the left side, they just don't notice it i. (will draw half of a clock but see it as a whole clock...nothing is wrong) ii. Thought to be a disorder of focused or selective attention (i.e, hemi attention) iii. Covert attention (or the cognitive spotlight) is impaired, rather than overt shifts in eye movement. In Posner's theory there are three stages in shifting covert attention a. Disengagement from a current focus (eye movement; look at something and cannot get away from it; perseveration on what they are looking at) b. Moving attention to a target (can be problematic) c. Engagement of the target (be engaged in the target and process it) iv. Thus, the patient can see the left side, but does not process it cognitively

what is the neuropathology of DAT?

neurofibrillary tangles: filamentous structures int he nerve ells, dendrites, axons and are thickened, twisted, and tangled neuritic plaques: aka senile plaues, minute areas of cortical and subcortical tissue degenration. cerebral ocrtex and hippocampus are especially vulnerable neuronal loss: nerve cells are destoryed by fluid filled cavities containing granular debris. loss results in a shrunken brian and the shrinkage is most obsvious in teh cerbral hemsipherses esp. temporal and parietal lobs neurochmeical changes: depletion of neurochemicals that help tranmit messages across brian structues such as acetylcoline, somatosatin, vasopressin and corticotropin

What are the treatment considerations for VP function?

neurologic stability severity/impact on speech intelligibility

What is stage 5 of ALS characterized by?

no functional speech

What is the prognosis/ treatment for ALS?

no known cure or effective treatment average life expectancy = 1 to 3 years after diagnosis develops between 50 and 70 years of age

What is the best approach for targeting velopharyngeal function?

no single best approach (i.e., behavioral, surgical, prosthetic)

What are the characteristics of broca's aphaisa?

non fluent, effortful, slow, halting limited output misarticulated speech/ speech sound distortions agrammatic or telegraphic speech impaired repetitions (esp. grammatical) imapried naming better auditory comprehension but nto normal difficuty understanding syntactic structure poor oral reading and comp. writing problems monotonous peech apraxia of speech right sided pariesis

What is the neuropathology of dyarthria?

non progreesive such as strokes, infections, TBI, congenital such as CP, Moebius syndrome, encephalitis, toxic effects of alcohol or drugs Degenerative diseases: ALS, Parkingson's, Wilson's, progressive supranuclear palsy, dystonia, Huntington's MS, Myasthenia Gravis, Primary Progressive Aphasia, Pick's Disease, Alzheimer's, Progressive Pseudobulbar Palsy Neurotraumatic: head, neck, skull fracture, surgical trauma Infectious disease: AIDS< Creutzfeldt-Jakob disease, CNS Tuberculosis Toxic metabolic: botulism, drug abuse, carbon monoxide poisoning, dialysis encephalopathy SOL: LMN, unilatealr or bilateral UMN, cerebellum and basal ganglia

what are the types of primary prgressive aphasia?

nonfluent (nfvPPa), semantic (svPPA), and logpenic (lvPPA) sometimes all considered a variety of FTD

What are the 3 stages of the tactile=cue method?

nonsense syllable drills, production of monosyllabic CS, and application of learned skills to production of multiword utterances and conversation

If there is no unifying motor control skills, what will be seen?

nonspeech oral tasks do not generalize to speech tasks performance at basic levels does not generalize to more complex tasks

What are the affects on the cranial nerves at Stage 1?

not affecting cranial nerves

What happens with nasal emission for ALS?

not prominent

Describe physiologic support in treatment of AOS?

not required

What is Charcot's triad?

nystagmus, diplopia and dysarthria

Describe "Spaced retrieval training"- adopted for memory practice

o (SRT) requires recall of material at increasing intervals between presentation and test/ recall o Conversely, it includes shortening the interval when there is recall failure.

What are some predictors of independent living?

o Attentiveness o Cooperation during testing o High scores on motor-sensory and cognitive evaluations

Describe Macrostructure: (overall structure) in TBI?

o CHIs produced a deficient number of cohesive ties and had additional problem with accuracy when telling stories. o Three general profiles came from the above: • Confused discourse soon after the injury, containing frequent inaccuracies, repetitions, and revisions • Cohesive discourse that is accurate but sometimes wordy or inefficient • Impoverished discourse with short utterances, little cohesion, and limited content o Published studies contain different conclusions however.

Describe pragmatics in Conversation: with TBI?

o Conversational interactions have been investigated much more frequently with CHIs than RHDs. . o CHIs have been described as especially subdued or requiring prompting to talk. o Behaviorally Referenced Rating System of Intermediate Social Skills (BRISS) was used to rate the problem-solving interactions of CHIs and their significant other and an opposite sex stranger. • With the opposite sex, CHIs were passive and appeared disinterested. • In problem solving interactions, word finding problems, lack of coherence, and use of inappropriate expressions hampered verbal communication o Another study looked at CHIs ability to give instructions to play a game to a naïve listener who was blindfolded. • Cohesion was not a problem, but statements were irrelevant or badly sequenced, making instructions very confusing. o Studies on polite, indirect requests: • Patients with CHI's attempts at indirect requests ended up being more impulsively direct than control subjects • The investigators concluded that "impaired problem-solving ability and poor behavioral control also disrupt normal social communication skills."

Describe how Drawing Gesturing can be used to facilitate communication?

o Drawing can be used to convey meaning to an observer, even if there is a certain degree of deficit as a result of the damage. o Drawing can be used as a communicative option. o Patients with LHD generally include accurate details and preserve the overall structure of an object, but they draw slowly and very simply.

Describe General recommendations for caregivers

o Educate yourself regarding DAT o Get appropriate medical care for your loved one o Make sure your loved one's legal documents are complete o Keep the impaired person active but not upset o Take care of yourself o Plan ahead o Solve problems one at a time o Share the burden o Join a support group

Describe Provide stimulation and environments to evoke positive memory, emotion and action

o Entertainment with music o Being involved in arts, crafts, or gardening o Sunlit and cheerful setting o Field trips to museums, art, etc. o Caregivers have noticed increased energy and talkativeness after visits.

Elaborate on Speech in regard to functional memory?

o Forgetting something you were told o Forgetting to tell somebody something important o Repeating story/joke already told

Describe Reading/Writing in regard to functional memory?

o Forgetting the sentence you just read, re-read it o Unabel to follow the thread of a story

describe Faces and Places in regard to functional memory?

o Forgetting where you put something o Can't recognize TV characters or famous people o Getting lost or turning in the wrong direction

How does Type of Stroke affect prognosis for recovery from stroke?

o Hemorrhage creates variable amount of recovery o Better recovery with hemorrhage than ischemic stroke o Blood flow gradually improved and correlated with recovery

Describe Naming in RHD?

o Naming common objects is okay, unlike LHD o No relationship between word/object sorting and object naming scores, RHD retain a high level of naming ability o Common lexical semantic knowledge is retained o However, more problems with lexical semantics than phonology and syntax o Semantic fluency (# of words per category): below normal and less typical than LHD; idiosyncratic or pragmatically deviant words produced (e.g., like for animal saying unicorn)

Describe how Conversational Gesturing can be used to facilitate communication?

o One function of conversational gesturing is communicative with either the automatic gestures that show emotion or the volitional gestures that express ideas o Gestures are also used for signaling conversational moves, thereby regulating an interaction. o For some severely nonfluent or global aphasias, gesturing may be considered a compensatory behavior.

Describe Microstructure: (within the structure) in TBI?

o One study looked at the completeness of narrative structure with respect to an initiating event, actions and a consequence marking the attainment of goal • CHIs produced no complete episodes for telling a story from a painting. o Other studies looked at levels of discourse. • One study looked at thematic coherence by judging topic maintenance through an entire discourse. • CHIs were distinctly impaired, contrary to their good cohesion and sentence form. • Deficits were described as being greater for "global" coherence than for "local" cohesion • Another study showed the two patients displayed opposite patterns of ability. • One had poor cohesion but good story structure and the other had poor story structure but good cohesion • Hough and Barrow found a dissociation between local and global coherence, with an impairment of global level reflected in thematic coherence o With some measures, identification of "deficit" depends on our frame of reference. Sociolinguistic variations need more exploration.

Describe Group discourse

o Programs for facilitating interpersonal communication with visual cues, conceptual associations, and questions with two-choice answers to support memory such as the 'Breakfast Club'

How does Severity of Impairment affect prognosis for recovery from stroke?

o Severity of brain damage: Larger lesions are related to less recovery which is most evident when comparing large and small lesions; Gradual expansion of lesion borders had no negative effect o Severity of language dysfunction: predictive of recovery o Negative correlation btwn severity of aphasia in early recovery period and amount of improvement which occurs during the recovery process whether or not speech tx is given o Patients with most severe disorders tended to change the most o Mild impairment had small amounts of recovery because of the ceiling effect o May depend on when the first test was administered o Distinguishing severe from moderate impairment at 15 days post-onset was related to spontaneous recovery over the subsequent six month period o Initial severity of auditory comprehension deficit appears to be a factor, high-comprehending subjects made much more recovery of expressive (word comp== better naming later)

Describe Learning new things in regard to functional memory?

o Unable to remember names of people you meet for the first time. o Forgetting to keep an appointment

Describe Errorless learning

o Used to improve people recognition and naming through the practice of fact-name associations o Accuracy is maximized by using the most familiar materials, providing plenty of cues, and repeating the successes.

What are some Management issues with bilinguals?

o Using wrong base language with monolingual o Extensive code-switching (not approp.) o Language mixing o Spontaneous translation o Failure to switch or translate upon request (cannot say it in English when you ask)

What is hyperreflexia?

overactive or overresponsive reflexes indicative of upper motor neuron disease

What are the prosodic characteristics of hypokinesia?

pallilalia - compulsive repetition of syllables festination of rate = decreased segment durations = increased syllables/second (>10)

What are the neurological characteristics of LMN?

paralysis (flaccid) hypotonia hyporeflexia atrophy fasciculations

What are the neurological characteristics of spastic dysarthria?

paralysis, spasticity/ hypertonia, hypereflexia, limited range of movement, slowness of movement, Drooling, pseudobulbar affect

How is the supraglottic swallow performed?

patient is asked to hold the food int the mouth, take a deep breath and hold it soon after initiating a slight exhalation, swallow while holdign the breath, and cough soon after the swallow.

Describe open head injuries?

penetrating Brain injuries involve a fracture, or perforated skull, torn or lacerated meninges, and an injury that extends the brain tissue. High velocity missiles (guns) and low velocity impacts (blows to the head) are the most frequent causes of penetrating brain injuries

What are the hallmarks of cerebral palsy?

persistence of primitive reflexes delays in achieving developmental milestones infant may display poor feeding ability, irritability, or disordered sleep patterns; later on, may evidence poor balance and an early hand preference primitive postural reflexes

What are the main goals that therapy may target?

physiologic support, intelligibility, stimulabitiy, and treatment affects on motor control

What is important about Motor status?

pick up spoon or fork. Ability to manage utensil, strength and endurance, apraxia, access to food, balance issues, hemiperisis- breaking apart food so it is in smaller bites== problems with posture. Lordosis or cyphotic- inabilty to get food into mouth and how can we fully assess this.

What are the phonatory disorders

pitch: abnormal pitch, pitch breaks, abrupt variations in pitch, monopitch, diplophonia, and shaky or tremulus voice Loudness: too soft or too loud, monoloudness, sudden or excessive variation in loudness, progressive decrease in loudness throughout the utterance, or alternating changes in loudness vocal quality problems: harsh, rough, gravelly voice, hoarse voice, continuously or intermittently breathy voice, strained or strangled voice, effortful phonation, or sudden and uncontrolled cessation of voice.

What are the factors involved in prompt?

place of contact jaw position manner tension (usually for vowels)

Describe random practice?

practice schedule in which different movements are produced in successive trials, where the target for the upcoming trials is not predictable.

How do you develop voluntary phonation?

produce reflexive behavior on a repetitive basis produce phonation voluntarily may need to position patient for maximal generation of Ps pushing exercises shape phonation into speech sounds

How do you establish respiratory support?

production of consistent Ps postural adjustments respiratory prosthesis

What are the components of the assessment?

record an extended conversational speech sample variety of speech tasks: imitation, production, sustained phonation diadochokinetic rate or AMRS, sequential motion rates

Describe global aphasia

profoundly impaired language skills greatly reduced fluency impaired rep, naming, and auditory comp perseveration impaired reading and writing intact responses to whole-body commands sometimes (stand up) Motor impairments difficult to determine comprehension, low arousal, disorientation/ confusion, depression/ lack of motivation Difficult to diagnose severity Dissociation with types of words

What is ALS?

progress degeneration of upper and lower motor neurons

What is MS?

progressive demyelinating disease characterized by remissions and exacerbations

How is respiratory laryngeal timing in improved?

prompt initiation of phonation decrease air wastage can use biofeedback

What is regularization paralexia?

pronouncing an irregular word according to the regular grapheme- phoneme conversion rules-sue for sew

What are the DAB characteristics of spastic dysarthria?

prosodic excess prosodic insufficiency articulatory-resonatory incompetence

What do you asses for lip movement?

protrusion and retraction (/u/ and /i/)

What do you asses for lingual function?

protrusion/retraction licking (circular motion) lateralization to corners and cheeks elevation of tip and back

What is the focus of AOS?

provide the greatest functional benefit most rapidly provide the best foundation for improvement over the course of treatment

How do you assess intelligibility?

provides an overall index of disability a primary goal of therapy for dysarthria is to increase intelligibility

how is nasality odified?

providing feedback on nasal airflow and hypernasality by using a mirror, nasal flow transucer, or nasendoscope.

What should we consider instead of task complexity?

providing the opportunity for a large number of trials (>100/session) training multiple target behaviors

What are the characteristics of myasthenia gravis?

ptosis diplopia progressive weakening of musculature with use

interarytenoid function

pulls arytenoid cartilages toward midline

geniohyoid function

pulls hyoid upward and forward

What is Bioness?

purely provides stimulation but not during functional task. Have to be able to participate in the therapy- have to demonstrate an initiation and then the stim will kick in.

salpingopharyngeus function

raises larynx, elevates lateral pharyngeal walls

How is judge familiarity controlled?

randomized sample selection procedure judges don't know which specific words or sentences are being produced all samples are selected, recorded and scored by an examiner who does not participate in judging the intelligibility samples

What are choreic movements?

rapid, coordinated but purposeless may involve any muscle groups may interrupt voluntary and automatic movements

Describe conduction aphasia

rare variety of fluent lesions between broca's and wernicke's supramarginal grus int eh inferiro parietal lesion sites are controversal similiar to wernicke's good to normal auditory comprehension some may have paresis on the right side of the face or limb oral apraxia and right sensory impairment will typically recover from these

What is affected by MS?

rarely affects PNS

Give example of 40 year old male with bulbar onset of symptoms?

rate 90wpm - 97% intelligible (9/99) rate 68wpm - 75% intelligible (11/99) rate 52wpm - 33% intelligible (2/00) rate 36wpm - 6.8% intelligible (5/00)

What was the effects of changes in rate and loudness on the acoustic space?

rate reduction had the strongest effect on vowel space for all subjects however, only control subjects showed a significant effect of loudness on vowel space stop consonant distinctiveness was maximized in the loud condition not seen for fricatives

What did Tjaden and Wilding 2004 study?

rate, loudness, and stress manipulation

What is visual dyslexia?

reading one letter at a time

describe non-invasive brain stimulation?

receptive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) have shown some benefical effects

How do you assess automated speech and singing?

recitation of the alphabet, days of the week, months of the year, and numbers prayers, poems, and nursery rhymes singing humming a tune

What are the principles of Melodic intonation Therapy (MIT)?

recognizes 3 prosodic aspects of spoken language phrases produced initially in unison with hand tapping - first with therapist, then independently, gradually faded Developed for aphasia, bypassing the left hemisphere- right hemisphere . Hierarchical phrases should have functional communicative content - promotes automaticity ability to generate novel, non-automatic utterance is also important child progresses in small steps through hierarchical levels

what are the necessary components when evaluating dysarthria?

record an conver

What causes spastic dysarthria?

results from loss of voluntary control of muscles and increased muscle tone (spastic paralysis)

Describe Language Changes in normal aging

reduced comprehension discourse changes naming difficulties due to interactions between cognitive, sociolinguistic, stylistic & neuroanatomic changes (generalized declines)

What is bradykinesia?

reduced speed of movement of muscle

What are the respiratory, phonatory, resonance, articulation, and prosodic disorders with hypokinetic?

reduced vital capacity, irregular breathing faster rate of respiration monopitch, low pitch, monolouness, and harsh and continously breathy voice reduced stress, inappropriate silent intervals, short rushes of speech, variable and increased rate in segments and short phrases imprecise or distorted consonants, stops sounding more like fricatives, mushy fricatives more frequently repeated phonemes and less frequently palilalia atypical but mild hypernasality

What is stage 3 of ALS characterized by?

reduction in intelligibility

Define flaccid dysarthria?

refers to dysarthrias arising from damage to lower motor neurons (cranial nerves) subserving speech musculature

Define extrapyramidal dysarthria?

refers to dysarthrias arising from damage to parts of the CNS concerned with motor function but which are not part of the pyramidal system (those which indirectly influence lower motor neurons)

What is knowledge of performance?

refers to nature/quality of movement pattern (e.g., biofeedback or "You should raise your tongue more.")

Define mixed dysarthria?

refers to those dysarthrias arising from damage to more than one level of the motor system neurological diseases that produce more widespread or diffuse effects,

What are the speech characteristics of ataxic syndromes?

reflect impaired coordination may have difficulty coordinating respiratory activity with other aspects of speech

What does disruption of coordinated movement reflect?

reflects failure to coordinate sensory data with motor performance

What are the fluent aphasias characterized by?

relatively intact fluency but generally less meaningful or even meaningless speech, generally flowing, abundant, easily intitated, and well articulated with good prosody and phrase length.

Describe compensatory techniques for articulation?

relies on ability to make adjustments in movement patterns in order to achieve acceptable speech may ultimately make acoustically acceptable compensations despite fact that movement patterns are nonstandard

Describe assessment of Perseveration of verbal responses?

repetitive verbal responses may be observed in recorded during interview and conversations with the patient

What is lingual facial buccal (orofacial) dyskinesia?

repetitive, slow, writhing movements limited to bulbar musculature may have a significant impact on intelligibility tardive dyskinesia

What are the respiratory, phonatory, resonace, articulation, and prosodic disorders?

respiratory: audible inspiration and forced and sudden inspiration or expiration not typical of other types of dysarthria phonatory: voice tremor, intermittently strained voice, voice stoppage, vocal noise, harsh voice, and loudness variation resonance: hypernasality in some cases but typically mild articulation: imprecise consonant productions, associated with distorted vowels and hypernasality; slower rate of speech prosodic: prolonged inter-word intervals, inappropriate silent periods, phoneme prolongations, excess and equal stress; monopitch and loudness, reduced stress, short phrases

What are the issues in the treatment of apraxia of speech?

response generalization and use of speech vs. nonspeech tasks.

What is Ballard's take on generalization?

response generalization of trained behaviors to novel stimuli if theories of motor control were applied in selecting and reinforcing target behaviors. Generalization should not be expected to occur between behaviors unless they share some fundamental, unifying motor control skill

Describe step 7?

response is elicited with an appropriate question e.g., "Would you like anything?'

How would you assess naming skills

responsive naming (what do you use to write? what color is snow congrontation naming word fluency (specific category)

Where is the lesion for spastic dysarthria?

results from damage to upper motor neurons of corticobulbar tract bilateral can have lesions in multtiple areas including the cortical areas, basal ganglia, internal capsule, pons, and medulla most commonly caused by multiple strokes that damage both the pyramidal and extrapyramidal tracts single storke in brainstem als, ms, tbi, brainstem tuomor

Define dysarthria according to DAB?

results from impairment of one or more of the basic processes (respiration, phonation, resonance, articulation, and prosody) involved in the execution of speech (Darley, Aronson & Brown, 1975).

What des flaccid dysarthria result in?

results from loss of voluntary control of muscles and decreased muscle tone (flaccid paralysis)

what do you assess for phonatory disorders?

say ah, after taking a deep breath not of patient's pitch, pitch breaks, diplophonia, abrupt variations in pitch voice tremors prescence of diplophonia, judge vocal loudness voice uality, efforful voice production or sudden cesstion

Describe the brief test of head injury?

screening test to evaluate adults with sever head injury. Orientation following command, and other relevant behaviors

what are some biofeedback or tools used for treating phonatory symptom?

see desirable vocal intencity, amplification systems or artificial larynx.

How do you select assesment measures?

select only those measures that are critical to the decisions that must be made regarding the client/patient

How can we train multiple target behaviors?

selecting more complex behaviors treatment becomes more difficult, but response generalization is more likely to occur to related behaviors that are of similar or lesser complexity order of presentation and reinforcement schedule

What is peripheral dyslexia?

sensory; reading due to impairments outside of the reading system

What does feeding development emphasize in stage IV?

separation of tongue and jaw movement development of well integrated rhythms in chewing emergence of greater speed and precision of tongue and lip movements

Who are the candidates for MIT?

should have adequate language 7-8 years of age with moderate to severe apraxia (but may be younger in some cases) utterance length of 3+ words attention span of 15-20 minutes

What is tardive dyskinesia?

side effect of (usually) long-term antipsychotic drugs grotesque movements of oral musculature symptoms are mostly irreversible

How do you assess comprehension of sentences, paragraphs, and discourse?

simple sentences/ compand perform actions breif and simple story that is told and follow up questions more complex senences understanding conversational speech

what is nontypological?

single disorder suggested

How do you assess comprehension of single words?

single items (point to your nose) and semantic groups of items (colors or animals) comprehension of words that vary semantic class and phonemic similiarity

How do you assess sentence and discourse production?

single sentecnes when a word is supplied multiple sentneces (tell me about your favorite sports team) discourse production (different pictures and describe) more spontaneous discourse (what he or she does on weekends.

How would you assess repetition skills?

single words (words with visible voiced consonants BEd, and blends and multisyllabic) object names, verbs, numbers, letters, function words sentences (sit down to progressively longer) few but infrequently used sentences

What are the other characteristics?

slow, fast, or irregular diadochokinetic rate and palilalia (compulsive repetition of one's own utterances with incrasing rate and decreasing loudness) as well asdecreased intelligibility of speech

Describe the conditions of Tjaden and Wilding?

slow, loud and habitual rate and loudness

Describe Reduced comprehension in normal aging

slower processing & organization short term memory easily "overloaded" difficulty ignoring irrelevant info Subtle difficulties may include inferencing, temporal order, integrating new information may not show in normal daily functions may appear for more demanding tasks.

What are some of the prosodic problems associated with AOS?

slower rate of speech difficulty increasing or changing the rate silent pauses between words impaired intonation because of increased duration of consonatns and vowels stress on syllabes, even loudness, resitrcted range of loudness, limited pitch range fluency problems include silent prhases and repeitions become false starts and attempts at self correction

Describe AOS?

slower rate of speech, distorted speech sound production, additions, syllable segmentation, articulatory groping, false starts and restarts, prosodic impairments, and longer utterances causing more errors than shorter utterances speech sound production errors combined with prosodic deficiences sensorimotor problems

What are the prosodic disorders?

slower, excessively faster, or variable rate of speech, shorter phrase length, and stress problems such as reduced, even, or excessive stress, prolongued intervals between words or syllables, inappropriate pauses in speech and short rushes of speech.

Define hypokinetic dysarthria?

slowness and poverty (paucity) of movement, damage to the basal ganglia, voice, articulation, and prosody most affect most often caused by degenerative parkinson's; also others

What are pendular reflexes?

smooth to and fro movements of limb after reflex is elicited reflexes may be normal or diminished

Describe mixed Transcortical Aphasia

somewhat rare variety between areas supplied by MCA and A and P Arteries isolates broca's, wernicke's, and arcuate fasciculus bilateral UMN paralysis, weakness of limbs (quadriparesis) visual field defects.

What is phonological paralexia?

sounds like a word "cambane" for campaign

Describe assessment of Dysarthria?

spastic dysarthria or mixed dysarthria in some patients with TBI are noted; these disorders may be assessed with standardized dysarthria assessment tools

What does UMN lesion result in?

spastic dysarthria. neurological impairments: unilateral lower face weakness, tongue weakness, palatal and hemiplegia/ hemiparis imprecise production of consonants, irregular articulatory breakdown and some vowel distortions, and sound or syllable reps harsh voice, reduced loudness, strained harshness, wet hoarseness, monloudness, low pitch short phrases hypernasality or nasal emission or combination dysphagia, aphasia apraxia and right hemisphere syndrome

What are the three CP syndromes?_

spastic, dyskinetic (athetosis), ataxic

*primary afferent input controlling the swallowing response is from the*

superior laryngeal nerve

What are the characteristics of spastic dysarthria?

spasticity and weakness: bilateral facial weakness, less severe lower face weakness, normal or near normal jaw movement movement disorders: reduced range force, speed of movement, loss of fine and skilled movement, increased muscle tone, imprecise production of consonatns, distorted vowels excess and equal stress, slow rate, monopitch, monloudness, redued stress, short phrases hyperaduction of vocal folds, continously breathy voice, harshness, low ptich, pitch breaks, strained and strangled voice quality, and short phrases predominant hypernasality due to inadequate closure of the velopharyngeal port

What are the neurologic characteristics of ALS?

spasticity usually present unless lower motor neuron damage is well advanced may be fasciculations and atrophy of tongue muscles pervasive weakness of oral musculature reduced range and slowness of movement predominance of spastic or flaccid paralysis cannot be predicted

What are some things speaking partners can do for individuals with aos?

speak slowly, use shorter sentences, reduce background noise, talk only when the client is focused, use total communication, augmentative communication if needed. goal is daily communication.

Describe stress testing tasks?

speech deterioration with prolonged effort should be able to count precisely at a rate of about 2 digits/second, for as long as 2-4 minutes

How you assess speech fluency

speech disfluencies (number per 100 words) speech tempo (spoken words per miute and MLU)

What is Festination?

speech or walking is getting away with them, slow to start, but then the movment almost seems like they are not controlling it. Only type of dysarthria where speech can be too fast.

What is surface dyslexia?

spelling-sound regularity is a strong factor. Regular words are read more accurately than irregular words- e.g. mint better than pint; cove better than love.

orbicularis oris function

sphincter muscle - closes/opens and puckers lips

What are fasciculations?

spontaneous contraction of denervated muscle fibers synchronous contraction of all the skeletal muscle fibers within a single motor unit

What do you look for with a Cough?

squeeze the vocal fold together and then build up pressure

What are some Voluntary vs. automatic tasks?

stick out your tongue and can do it when you give them ice cream---- apraxia

What voice qualities are improved?

strain/strangled and breathiness

What is Physiologic support?

strengthening May give them the frenchay to see what is weak, then see where to start and what will be done.

What are the techniques to normalize function of articulators?

strengthening, stretching, resistance exercises, and compensatory strategies

What is Pallilalia?

stuttering like quality; whole syllables, not sounds.

What can result from the extracerebral hemmorage?

subarchnoid (near circle of willis), subdural, and epidural varietes of stroke.

what arethe symptomes of early stage DAT?

subtle meory problems somewhat pronounced difficulty with new learning and visuospatial problems behavioral changes such as self-neglect and avoidance of routine tasks may have depression slight disorientation in new surroundings

Describe Naming Difficulties in normal aging

subtle naming problems may exhibit semantic paraphasias delayed or extended responses circumlocutions

What is important Compensatory strategies?

such as pushing head down when you swallow- may not want to use these strategies in day to day.. Hard to have someone to take into consideration all other factors and the problems that come with it.

What does EMG data suggest for cerebellar damage?

suggest that there may be difficulty in building up muscle force and, once achieved, activity cannot be rapidly suppressed (possible explanation for rebound and dysmetria).

Describe the touch cue method?

tactile facilitation approach recommended for the most severe apraxia tactile cues for limited number of sounds which are addressed in a specific order through progressively difficult levels CV to CVC to VC, etc.

What is a common reason for lack of treatment generalization?

task complexity

Describe Prompt?

technique for reshaping sounds and sound sequences physically shape productions and transitions different prompts for each English phoneme various factors Tension: tense, lax vowels Good for nonverbal and those who have difficulty controlling speech, ASD

What is the necessary protocol for assessment instruments?

test results should be applicable to therapy test results should be sensitive to change test should be efficient and easy to use test should be standardized* test results should be easy to communicate

What is the assessment for sustained attention?

tested by having participants watch the lights go on and off and pressed a button whenever a target light appeared (when this light appears that's when you press the button) CHIs were slower (remember, those with aphasia process thing slower) than but as accurate as normals. A common complaint is the struggle with concentration: The digit symbol subtest of the WAIS Measures concentration and produced the largest deficit with CHI pts. did not show a deficit with clear stimuli; reduction of vigilance depends on the task There is a growing body of evidence that mild CHI can lead to measurable deficits in cognitive functioning

What is functional communication and how is it assessed?

the ability to receive or convey a message, regardless of the mode, to communicate effectively and independently in a given environment. It is assessed to measure how well a patient can 'functionally' and independently use his communication in everyday life. The main idea in assessing functional communication is to ensure that services are helping a patients progress in activities that are essential for daily living and, thus, maximize independence from the health care system.

What is meant by spontaneous recovery?

the brain "heals itself;" our Tx may or may not help - "however, we should not stop tx just because we have gotten past the 6 month mark". Significant progress during the first 3 months post onset, some 3-6 months post onset, and often no change after 6 months (Dr.K think ppl cont. improving). However, recovery can continue at different rates for years after the infarction

~Describe treatment Impaired reasoning

the clinician can use activities that require reasoning and prompt and reinforce correct and logically sequenced descriptions

Treatment of right hemisphere syndrome denial and indifference?

the clinician provides immediate feedback on errors to increase awareness. Videotaped sessions to give visual feedback on errors are helpful

What is hyporeflexia?

the condition of below normal or absent reflexes associated with a lower motor neuron deficit

What is flaccid dysarthria known as?

the dysarthria associated with flaccid paralysis is referred to as bulbar palsy Lower- extrafusal moving mslces- alpha Tone- gamma When you damage lower- damage alpha and gamma and "Bulbar"- brain stem--- paralysis due to cranial nerves==== lower motor neurons.

What is dysarthria associated with spastic paralysis?

the dysarthria associated with spastic paralysis is referred to as pseudobulbar palsy (due to clinical resemblance to bulbar palsy)

palatopharyngeus

vagus and accessory

Define praxis?

the generation of volitional movement patterns for the performance of a particular action, especially the ability to select, plan, organize and initiate the motor pattern which is the foundation of praxis (Ayres, 1985)

What is the goal of respiratory treatment?

the goal is to achieve constant Ps during speech that results in minimal fatigue with breath groups of adequate length

What is akinesia?

the inability to initiate movement due to difficulty selecting and/or activating motor programs in the central nervous system. It is a result of severely diminished

Define Tactile agnosia?

the inability to recognize an object by though, even though the person senses pain, temperature, and texture associated with lesions in the parietal lobe and characterized by impaired tactile recognition when visual feedback is blocked

~Describe treatment impaired attention

this involves drawing attention to treatment stimuli, giving specific directions to follow, repeating such directions throughout treatment, reinforcing attention during discourse training, and stopping the patient whenever he or she wanders away from the topic of discourse

What is the etiology of MS?

thought to be an autoimmune response

What is hypotonia?

thought to be associated with the disruption of afferent input from stretch receptors and/or lack of the cerebellum's influence on the system that innervates intrafusal muscle fibers, thereby controlling muscle spindle sensitivity

Describe two types of Ischemic strokes

thrombosis and embolism

What is the goal of the Mendelsohn maneuver?

to Increase extent and duration of laryngeal elevation and UES opening; increase coordination of the swallow

What is the goal of the supraglottic swallow?

to close vocal folds before and during the swallow

What are other reasons for assessment?

to confirm presence of a particular disorder (e.g., ALS) to determine severity of dysarthria associated with a particular disorder to identify appropriate treatment goals to identify effective intervention strategies (i.e., treatment plan) to make recommendations about alternatives to verbal communication

Describe sequential motion rate tasks?

to determine ability to move quickly from one articulatory posture to another (e.g., ptk)

What is the goal of vocal cord adduction?

to improve airway protection 1.

What is the goal of the Valsalva Maneuver?

to improve closure at the vocal cords

What is the goal of tongue base retraction?

to improve tongue base to pharyngeal wall contraction.

What is the role of the Shaker Exercise?

to increase UES opening

What is the goal of resistance tongue exercises?

to increase bolus transport and control

What is the goal of buccal exercises?

to increase buccal tension

What is the goal of bolus control exercise?

to increase lingual control of the bolus

What is the goal of posterior lingual elevation?

to increase oral control

What is the goal of the effortful swallow?

to increase posterior motion of tongue base during pharyngeal swallow.

What is the rationale of working on non-verbal modalities for communication?

to maximize functional communication to supplement or replace impaired language functions with another means of communicating, especially for the acute period following stroke or for chronically severe or global aphasia. "Aphasic people communicate better than they talk"

What are the reasons for assessing intelligibility?

to provide an index of severity of overall disability = functional indicator to provide an indicator of the integrity of all the components of the speech act (i.e., articulation, respiration, VP function, phonation)

What is the tactile=kinesthetic approach?

touch cue method

Describe the amalgamated hypotheisis?

tow or more languages can better account for the differential recovery of languages following strokes in bilingual speakers

What are the early neurological characteristics of ms?

transient diplopia or blurred vision (optic neuritis) transient parasthesias mild weakness

~Describe treatment Impulse behavior

treatment includes nonverbal signs to wait a few seconds before giving an impulsive response. Also helpful verbal stimuli such as, "wait for a few seconds and then tell me"

~Describe treatment Impaired comprehension of metaphors and idioms

treatment involves practice in the correct interpretation of metaphors and idioms by asking the client to select printed statements or make comments that give literal, metaphoric, and implied meanings

~Describe treatment of Visual neglect

treatment techniques include a thick and colorful line drawing on the left margins of printed pages to force attention to the text on the left side. Teaching the patient to keep a finger on the left side of the page, pointing to the beginning of each line, frequent verbal prompts to pay attention to the neglected side of the body, and generally providing plenty of positive reinforcement for attending to objects on the left side and on the left side of the body

What is intention tremor?

tremor during movement, not at rest

What are the characteristics of hypokinetic dysarthria?

tremors: facial, mouth, and limb muslce tremors at rest mask-like face: infrquent blinking and no smiling micrographic writing: excesssively small print walking disorders: slow to begin, then short, rapid, shuffling steps postural distrubances: involuntary flexion of the head, trunk, and arm with difficulty changing positions decreased swallowing: accumulation of saliva in the mouth

digastric (anterior belly)

trigeminal

lateral pterygoid

trigeminal

masseter

trigeminal

medial pterygoid

trigeminal

mylohyoid

trigeminal

temporalis

trigeminal

tensor veli palatini

trigeminal

anterior 2/3 of tongue innervation for general sensation

trigeminal via the lingual nerve

Describe an infant at 6 months?

true sucking pattern emerges tongue movement shifts from simple back-forth to up-down

Describe the Amsterdam-Nijmegen Everyday Language Test

two parallel forms: each contianing 10 items to assess pragmatic skills related to dialy living activiites.

What is the assessment for divided attention?

two stimuli or tasks; response to both (dual task paradigm) Evaluated with the new Letter—Number Sequencing subtest of the WAIS--III To test divided attention patients are presented with alternating letters and numbers, increasing in length from 4 to 18 units One form asks patients to ignore the letters and count the numbers and the other form asks to do the opposite

What is the assessment for selective attention?

two stimuli or tasks; response to one (e.g., dichotic listening) The Stroop Inference Task: A colored naming task in which the printed names of the color are typed in a different color (red). The color name is a distractor and the person is asked to name the color of the print. CHIs were slower than but as accurate as normals, indicating that focused attention was intact in the Stroop task.

What is the onset of MS?

typical onset between 20 and 40 years of age

Define Expressive agnosia?

unable to perceive facial expressions, body language, intonation

Define ataxic dysarthria?

uncoordinated voluntary movement hypotonia the feedback loop is damagd

What are the effects of unilateral damage for UMN?

unilateral damage has transient or mild effect on speech

What is the etiology of ALS?

unknown etiology

What is myoclonus?

unsustained muscle contractions that occur on an irregular basis may affect muscles of limbs, face, oral cavity, larynx and diaphragm

muscle types in esophagus

upper 1/4 striated, middle 1/4 mixed striated and smooth, lower 1/4 is smooth

Describe when you would use strengthening exercises for articulation?

use only if weakness interferes with speech contraindicated if weakness is progressive (e.g., ALS and MG) flaccid dysarthrics are best candidates

Describe Subcortical Aphasia?

usually with extensive left subcortical damage, esp. basal ganglia and thalamus infarctions deep and wide, damage primarily beneath cortex in left hemisphere Key areas: internal capsule, lenticular nuclei, thalamus More motor and sensory impairments Anterior: like Broca's with intact grammatical form Posterior: like Wernicke's

levator veli palatini

vagus and accessory

musculus uvulus

vagus and accessory

What is sustained attention?

vigilance or concentration; maintaining focus on one stimulus for a period of time Assessment: a series of stimuli and response to one; patient asked to concentrate on a boring task for 20 minutes

What kind of dysarthria comes from Bell's Palsy?

virus that affects the seventh nerve.

What is Phonatory incompetence related to?

vocal fold paralysis

What is Stridor?

vocal fold vibrating on inhalation

What are the characteristics of Flaccid dysarthria?

weakness, hypotonia, atrophy, diminished reflexes, isolated twitching of muscles (fasiculations) contractions of individual muscles (fibrillations) rapid and progressive weakness with the use of a muscle and recovery with rest reduced subglottic air pressure, weak inhalation (with damage phrenic nerv and paralyzed diaphragm) breathy voice and audible inspiration, and short phrases hypernasality and nasal emission adn short phrases harsh voice, monopitch and monoloundess or reduced loudness imprecise consonat and weak pressure consonants (more pronouced with lessions of cranial nerves V, VII,and ZII)

Not appropriate for someone with reduced labial seal- will come out; and not for those with difficulty with bolus transport Good for someone with a delayed swallow initiation. Very unnatural when eating a meal with someone, wears down on neck.

what are the directions for chin-down?

What happens with rate with ALS?

when rate decreases to half of normal (about 100 wpm), a precipitous decline in intelligibility may be expected.

What will happen with Paralysis in velum?

will pull toward the strong side and weak side will lag behind.

What are some questions to assess communicative effectiveness?

with familiar persons in a quiet environment with strangers in a quiet environment with a familiar person over the phone with a stranger over the phone with someone at a distance with someone in a noisy environment for a long period of time before a group while traveling in a car

What happens with rest for myasthenia gravis?

with rest my spontaneously get better

How is Anterograde amnesia studies?

with tasks that require the recall of recently presented information—thus, commonly consists of new learning procedures One example is a paired associate learning task -A list of unassociated word pairs is presented for a subject to study (e.g., window—reason)

What are the factors influencing intelligibility?

words vs. sentences transcription < completion < multiple choice naive vs. experienced listeners familiarity with speaker and/or message

describe pure alexia?

writing and other skills intact due to a lesion in the inferior occipitotemporal region --- visual cortices and Wernicke's areas are separated in patentts

Describe step 6?

written stimuli, with delayed production following removal of written stimuli

is bite block proven to help oromanidbular dystonia?

yes two case studies

When is prognosis better?

younger and healthier better educated and in verbally demanding occupations smaller lesions no other medical or behavioral disorders good hearing acuity normal or adequately corrected vision better motor skills preserved language skills aphasia is less severe treatment is initiated after onset family members are involved in treatment maintain hteir healht during the ocurse of treatmtnet.

Describe Lewy Body dementia?

~~ excessive protein deposits may confused with DAT

Treatment of disorders of the oral phase involve?

~~1. teaching the patient to place the tongue on the alveolar Ridge and initiate a swallow within upward and backward motion to prevent tongue thrust swallow 2. teaching the patient to compensate by placing food at the back of the tongue and then initiating a swallow 3. teaching the patient to compensate for tongue elevation problems by placing food posteriorly in the patient's oral cavity, placing a strong almost at the level of the faucial arches to help the patient swallow liquid, and then tilting the patient's head back and letting gravity push the food from the oral cavity to the pharynx 4. teaching the patient to compensate for disorganized anterior to posterior tongue movement by holding the bolus against the pallet with the tongue I'm beginning the swallow with a strong, Single, posterior movement of the tongue

The supraglottic swallow?

~~helps close the airway at the level of the vocal fold to prevent aspiration. The patient is asked to hold the food in the mouth, take a deep breath and hold it soon after initiating a slight exhalation, swallow while holding the breath, and cough soon after swallow

Describe Recall on the Wechsler Memory Scale indicated RHD?

• A normal amount of essential information • Fewer details • More intrusions than normal controls • Reduced informativeness of description or narration • Some may be verbose, others: paucity of utterance • Emotional content impaired RHD's discourse and seemed to facilitate aphasic discourse May depend on our choice of methods of elicitation and analysis RHD more difficulty with semantic fluency than first-letter fluency Generated fewer words than normals Sporadically produced idiosyncratic or pragmatically deviant words, not produced by normals

What may metaphor comprehension Deficit may be due to?

• Activation theory:difficulty activating multiple meanings • Suppression theory: fail to inhibit the activation of possible meanings, which then interferes

Summarize the NON-OME?

• Advances in the understanding of normal and disordered speech motor control should be incorporated into treatment approaches. • Theories of motor control should be more rigorously applied in developing hypotheses and selecting behaviors to examine generalization.

What are some of the SECONDARY FACTORS that may affect prognosis for recovery from stroke?

• Age at Onset (predictor not a factor) • Gender • Handedness • Race (not shown to matter) • Time of initial test Additional: history of previous stroke, length of hospital stay, education, motivation, morphological asymmetry

Elaborate on Language Production in bilingualism?

• Agrammatism different for languages, depends on grammatical morphemes • Reliance on canonical order appears to be universal feature of aphasia • Omissions occur more often in English that in other languages. • Each language is impaired; maybe impaired equally or differently

What conclusions can be drawn from research in RHD pts who used American Sign Language??

• American Sign Language and RHD patients o Some studies looked at left neglect with patients who used ASL and noted they sign on the left side of the signing space (despite neglect of L-hemisphere space in non-language tasks) o In terms of the spatially configured syntactic component and ASL (visuospatial expression), a study of three RHD signers who were impaired in comprehension of syntax were not impaired in other components of language (they do okay with production of signs but not comprehension of signs that have syntactic info.) • They were "flawless" in production of syntactic and other features of ASL • ASL case study of a pt w/ R parietal lesion: great difficulty matching objects that had been rotated, but no problem with locative signs • The linguistic use of space is a different process from the nonlinguistic use of space (i.e. rotating text)

Describe Amount as a measure of recovery of language?

• Amount of improvement is determined by subtracting an earlier test score from a later test score. The result is difference score or change score. • Aphasic patients are widely variable in amount of recovery • Treated aphasic patients display similar variability • Statistical significance vs. clinical significance, small change may be clinically significant

Describe RHD and Porch Index of Communicative Ability (PICA) performance?

• As severity of deficit increases, the difference between aphasia and RHD becomes more pronounced • A difference in verbal expression becomes pronounced at a higher level (50th percentile) favoring RHD • On the nonverbal subtest (copying shapes), RHDs have a lower score than LHDs • It is important to note that there are standardized tests specifically to assess patients with RHD

What are the findings on mouth awareness?

• Aside from some phonetic placement cueing, a review of the literature questions the need to teach "mouth awareness." • We don't really know at what age children have this awareness. • Studies have shown that 7- and 8-year olds aren't very aware of the structures in their mouths or their relationship to speech production.

Describe using NS-OME to teach "mouth awareness"?

• Aside from some phonetic placement cueing, a review of the literature questions the need to teach this. • We don't really know at what age children have this awareness. • Studies have shown that 7- and 8-year olds aren't very aware of the structures in their mouths or their relationship to speech production.

What are the principles for facilitating progression through the 8 step continuum?

• Begin with easiest sounds (e.g., vowels, nasals, stops), then move to more difficult (e.g., fricatives, affricates, clusters) • Gradually increase distance between points of articulatory contacts in words (e.g., bib to bid to big) • Choose initial sounds of target words according to degree of phonetic complexity • Gradually increase the length of target words. • Start with short words with repeating syllables (e.g., bye-bye) • Systematically begin using longer words with more complex syllable structure

How does Wernicke's Aphasia affect prognosis for recovery from stroke?

• Bimodal distribution of recovery • Poorer outcomes at eight months than the other syndromes • All patients with good recovery had damage in half or less than half of Wernicke's area, whereas all poorly recovered cases had larger lesions

What is the argument for the statement "Cant do any harm?"?

• Dynamic systems principles suggest that oral-motor exercises may be harmful "by laying a framework of movement patterns that are contrary to those used in speech."

What are the conclusions on NS-OME?

• Empirical studies of NS-OME do not show any benefit for the remediation of speech disorders . • The evidence suggests the "importance of coordinated movement in speech production and questions the utility of treatment protocols that do not encompass an organizational scheme that is comparable to that found in speech production." • The use of simple behaviors as a way of promoting mastery of complex behaviors is not supported. • Moreover, training on a part of a behavior does not improve learning the whole behavior.

Describe Final Outcome as a measure of recovery of language?

• End of recovery is usually demonstrated with a series of measures showing a plateau of slightly variable scores, final linguistic outcome usually falls short of normal function • Do not return to normal function because loss of brain cells is permanent, restrains recovery • say "progress" or "improvement" not recovery. • Quality of life • the less impaired aphasics have more difficulty accepting jobs that are less demanding then their previous job

What factors may negatively influence Patient Selection for Tx (esp. when there are limited resources)?

• Etiology: Is it a progressive neuropathology? (such as Alzheimzer's disease) • The patient is too severe to treat or requires an expensive therapy • Patient is too sick or demented • Has a mild condition and thus, cannot receive services because he/she does not qualify. Even so, these individuals may (and then again, they may) need therapy aid in their recovery

Describe Rate as a measure of recovery of language?

• Final score at termination of treatment may underestimate and a peak score achieved before treatment was terminated may overestimate the time that recovery stops. • Progress is more rapid in the first two or three months post-onset than in any period thereafter • Progress after 6 months attributed to therapy. • Rate is variable among individual patients • Some (basically all) make progress beyond the first year

Describe target agility, not strength?

• For a child or adult with AOS, don't work on static postures or even individual sounds. • Don't do exercises that promote movements not used in speech (e.g., tongue wagging or protrusion). • "People are trying to build agility by using gross movements that have no relevance to the actual production of sounds" (Lof, 2007)

What did lof 2007 find?

• Found that 85% used non-speech oral-motor exercises (NS-OME) with the goal of changing speech sound production • 87% of respondents reported that they learned these exercises from non-peer-reviewed sources. • 61% agreed with the statement that "The literature I have read strongly encourages the use of NS-OME." • Most did not know whether or not there was any evidence for this practice.

Regarding discourse comprehension and production in aphasic pts, what are a few general conclusions that can be drawn?

• In general, overall story structure was found to be preserved but coherence was reduced in other respects. • Wernicke's patients produced more irrelevant sentences • Brocas and Conduction aphasic patients were more coherent • The microlinguistic level has been studied more and more effectively than the macrolinguistic level • Coherence, density of different words, t unit, microlinguisitc analysis, macro linguistic, cohesion, informativeness Comprehension: microstructure, main ideas, informativeness.

What do RHDS have more Difficulty with in regard to discourse?

• Inferring relations between propositions • More errors with inferences than with factual statements, indicating a deficiency in combining information between sentences (i.e., bridging inference) • E.g., Given the sentence "George left the bathtub water running," and "George cleaned up a mess in the bathroom" the bridging inference would be "Overflow." However, RHD patients in a visual-lexical decision task responded more slowly to inference related targets (e.g., overflow) • Have problems with the coherence feature of a narrative • When pts fail to pick up a correct punch-line in a joke, they err in favor of surprise over coherence • Impaired relative to normals but could still use context to comprehend an indirect message • When conclusions of a closing comment were literally false, RHD had difficulty detecting sarcasm based on the character's relationship (See above study) • Inference revision is especially strenuous for people with RHD • Difficulty arranging sentences into a story and sequencing frames of a cartoon o RHD scored better when the theme wasn't delayed Patients recognize common macrostructure, and exceptions to the common macrostructure create problems for processing narration

What are the general theories/ideas regarding language representation in bilingual persons?

• It is thought that the Left hemisphere is dominant for both Ls. Most bilingual pts show similar impairments in both Ls; some intermingle words, phrases & SÕs from both Ls (Hegde, 1998). • Some researchers believe that cerebral representation in polyglots is not entirely the same as in monolinguals; the Ls may not be subserved by the same neuronal circuits or be represented in the same hemisphere (Lecours et al., 1984, Segalowitz 1983, Lebrun 1981).

What are Lof's findings on NS-OME?

• Lof discounts us of NS-OME for strengthening • Studies have shown that only 10-15% of maximum strength is required for speech • Studies have not found that kids with speech errors have less strength than kids without

What is the argument for "I don't know what else to do, and my client seems to be experiencing some success."?

• Must remember that the underlying disorder is a speech disorder, so that success in a nonspeech activity is not relevant to the problem.

What may be used as an outcome indicator?

• One outcome measurement is discharge destination is an indicator. Discharged to home (a good outcome) or long-term institutionalized care (a poor outcome) • Functional Independence Measure (FIM)

What are the philosophies of cognitive sitmulaiton?

• Treat underlying processes of aphasia (you do not do stimuli and response therapy). • Target specific processes, not stimuli and responses. • This may affect several abilities that rely on the process: word-finding improves sentence production as well. • General (mental) processing systems: Comprehension Production Word-finding • Elicit a variety of responses in each system • We want accurate responses

Describe Pattern (it "see saws") as a measure of recovery of language?

• Overall measure is less informative than attending to specific communicative functions • Patient may progress in 1 function while regressing in another but this would balance out in an overall score. A person's overall score will not be indicative of skill changes. • Comprehension fares better than verbal expression in early spontaneous recovery. Auditory comprehension has had a better outlook for treated patients • Broca's, conduction, Wernicke's usually become anomic when recovery reaches a plateau • Patient may end up with a syndrome that differed from initial diagnosis. Evolution of aphasia may exhibit day-to-day fluctuations or gradual over weeks and months Those who changed syndromes progressed a greater amount than those who did not change syndromes, indicating that good recovery pushes a patient through different patterns of impairment.

Describe INSIGHT AND EMOTION with TBI?

• Patients are often unaware of behavior or personality changes, nosoagnosia linked to frontal lobe damage. • Post-traumatic insight disorder: patients with CHI may not complain about physical disabilities. These patients underreport the severity of the impairment. • Patients with mild or severe head trauma often underestimate their memory impairments. They may realize their memory is worse but not the severity (how much words it is). • impaired CHIs and spinal cord injuries were equivalent on measures of emotional, psychological, and physical problems. • Severe CHIs were distinctive in being more bewildered, depressed, and hostile.

Describe Interpreting Situations in RHD?

• RHD patients experience difficulty recognizing emotion or humor in a pictured scene, whereas aphasic patients do not have this problem • More difficulty sorting according to implicit themes (e.g., love) than explicit themes (e.g., hugging). Thus, they have problems with inferring the nature of situations when it is not concrete or obvious. • Cookie Theft Scene from Boston Exam: study looked for literal content (e.g., a woman) and interpretive concepts (e.g., She is the mother) • Found RHDs produced fewer interpretive concepts than normal indicating impaired situational inference • Difficulty in taking the point-of-view of a listener, esp. in being sensitive to the other person's needs

Describe RHD and WAB performance?

• RHD patients perform considerably better than stroke induced aphasic patients on this test • RHD more homogenous on a language evaluation and perform better (score: 93) than LHD (score: 54)

Describe Support working memory

• Reducing distractions • Writing down a topic or important information • Keeping statements short and simple

How do you assess RHD?

• Rehabilitation Institute of Chicago Evaluation of Communication Problems in Right Hemisphere Dysfunction (RICE): general behavior patterns, visual scanning and tracking, writing, pragmatic communication, metaphorical language • Right Hemisphere Language Battery: controls for visual perceptual deficits in assessing lexical-semantic comprehension, metaphor appreciation in listening and reading, verbal humor appreciation, comprehension of inferred meaning, production of emphatic stress and conversational discourse • Mini Inventory of Right Brain Injury: primary impairments, affective language behavior, pragmatic language such as humor and metaphor

How does Type of Impairment affect prognosis for recovery from stroke?

• Size and location of lesion may be prognostic indicators with respect to particular syndromes • Site of lesion in LH has a pronounced effect near Sylvian fissure or in the borderline areas encircling the primary language zone, transcortical aphasias • Subcortical lesion, improvement of blood flow related to best recovery • Thalamic hemorrhage, aphasic symptoms disappeared completely by end of second month • Subcortical lang deficits generally resolve dramatically over time

How does Global or Severe Aphasia affect prognosis for recovery from stroke?

• Some cases evolved to other forms of aphasia by the time of acute hospital discharge, others remained global for months • Verbal expression changed • Chronic global had minimal or no change • Pockets of progress in specific functions can occur • 5 types of lesion that caused global 1 month post-stroke: o 1: large middle cerebral artery infarction o 2: anterior infarction, variable damage o 3: subcortical infarction o 4: parietal infarction with supramarginal and angular gyri o 5: frontal and temporo-parietal regions • subcortical group had best prognosis, types 2 and 3 sometimes recovered completely • Prognosis poor for type 1 • Presence of global at 1 month post-onset is an ominous prognostic sign

How does Broca's Aphasia affect prognosis for recovery from stroke?

• Spontaneous improvement • Greatest amount of recovery and varied outcomes of fair, good and excellent • Remain in came category or progress to a milder form of fluent • Less damage in 2 subcortical areas

How do you probe for generalization ?

• Stimulus (trained response to stimuli that differ from treatment) and response generalization (untrained response to the stimuli used in treatment) can be observed with what researchers call a "generalization probe" • probe takes a few minutes to administer and is usually done at the end of the session (sometimes called a "post-session" probe) • given daily, on alternate days, or one per week. • at least 10 items used and task administered same way each time • systematic approach to probing is illustrated with matrix training: i.e. with Gesture Training they trained a few agent-object messages with the hope of improved gesture production in 25 additional combinations not trained; items a short distance from training (e.g. those with same nouns/verbs but different combinations) were assessed as well as though with a far distance. All subjects improved with untreated gestures. • GP tell us whether or not we are meeting our goal (treatment is a means to achieve the goal) • generalization is the observation of improvement in something other than the treatment

Describe Discourse Production in RHD?

• There may be extended verbal expression but it is often empty • Some patients are too literal and include irrelevant information • E.g., when describing the Cookie Theft picture from the Boston Exam, RHD patients may tell the clinician it is on 8 and half by 11 inch paper, it looks like it may have been drawn, etc... • RHDs have been said to wander from the point or theme when telling stories • Pts are more accurate when retelling a story told to them rather than read to them

Describe sentence intelligibility?

• Transcription • Speaking rate • Rate of intelligible speech • Communication efficiency ratio

What are some of the PRIMARY FACTORS that may affect prognosis for recovery from stroke?

• Type of Stroke • Severity of Impairment • Type of Impairment

Elaoborate on language comprehension in bilingualism?

• Universal thematic roles of agent and recipient conveyed through linguistic cues like word order and grammatical morphemes • Retention of grammatical knowledge is similar across languages • SVO sequence used more in English o If a language includes who and to whom, the order wont matter. • Canonicity is more important than surface structure • We can ID word order errors easier in English than inflection-dependent errors o In English you have to say he goes, you go, etc in other languages it may be included such as in Spanish. o In inflection: he see girl makes sencse but when the inflection indicates who such as see girl, who don't know who

List two Aphasia batteries that an SLP may use to assess language abilities ?

• Western Aphasia Battery (WAB) • Porch Index of Communicative Ability (PICA)

Describe how metaphor comprehension is worse in RHD?

• When given phases like heavy heart and colorful music • RHD patients could paraphrase the intent of the phrases but still chose pictured literal meanings more often than aphasic individuals • For RHD, idioms were more difficult to understand than novel sentences, for aphasics the opposite pattern was seen (novel easier than idioms)

Describe PTA duration in regard to prognosis for recovery?

• With severe TBI, PTA (post traumatic amnesia) exceeds one day • Longer the PTA, more difficult to recognize exactly when it ends and ID of the end of PTA can be off by 1-2 weeks • Progress slower after until 2 years post-onset • Functional level by 4 months post-onset, normal levels on aphasia battery by 6 months

How do you Measure progress?

• charting performance of treatment tasks • repeating sdzd test (e.g. pre-post tx test scores) • regular probes of specific goal-directed tasks that are independent of tx.

Describe Lof's position?

• discounts us of NS-OME for strengthening • Studies have shown that only 10-15% of maximum strength is required for speech • Studies have not found that kids with speech errors have less strength than kids without

Describe task specificity?

• even though the same structures may be used for speech and nonspeech tasks (e.g., speaking and eating), those structures do not work the same way in those tasks • evidence that the natural organization mechanism of the brain is focused on tasks rather than muscles groups

Describe task specificity?

• even though the same structures may be used for speech and nonspeech tasks (e.g., speaking and eating), those structures do not work the same way in those tasks • linked to the natural organization mechanism of the brain, which is focused on tasks rather than muscles groups • There is little evidence that practice on a part of a task (e.g., subunits of a target phone, such as movement of a single articulator) increase the rate and accuracy of learning of the whole (e.g., accurate production of the target phone)

What are the main identifying features of treatment of DAS?

• variability of errors • limited phonetic repertoire • atypical errors • less difficulty with automatic as opposed to novel utterances • increased errors with increasing word or utterance length